Industry Research

Pharmacoeconomics

Published in 2003

Cox ER, Motheral BR, Mager D. Verification of a Decision Analytic Model Assumption Using Real-World Practice Data: Implications for the Cost Effectiveness of Cyclo-oxygenase 2 Inhibitors (COX-2s). The American Journal of Managed Care. 2003;9(12):785-794.

The purpose of this study was to verify the gastroprotective agent (GPA) rate assumption used in cost-effectiveness models for cyclo-oxygenase 2 inhibitors (COX-2s) and to re-estimate model outcomes using rates from actual practice data. Prescription and medical claims data from a large preferred provider organization (PPO) in the Midwest was used in the analysis. Members were at least 18 years of age and were new to nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) and COX-2 therapy. GPA estimates were obtained for 3 patient groups, 1) all new NSAID users, 2) new NSAID users with a diagnosis of rheumatoid arthritis (RA) or osteoarthritis (OA), 3) and a matched cohort of new NSAID users. Results showed that contrary to published model estimates, GPA use is positive and marginally higher among COX-2 users than among nonselective NSAID user. Re-estimation of the cost-effectiveness model using the actual practice rates increased the cost per year of life saved for COX-2s from $18, 614, or that COX-2s are cost-effective to a cost per year of life saved of more than $100,000, a value considered unacceptable from a cost-effectiveness perspective. These findings call for a re-evaluation of the cost-effectiveness of COX-2 therapy.

Fairman KA, Motheral BR. Do Decision-Analytic Models Identify Cost-Effective Treatments? A Retrospective Look at Helicobacter Pylori Eradication. Journal of Managed Care Pharmacy 2003;9(5):430-440.

The purpose of this study was to examine retrospectively whether H pylori pharmacoeconomic models direct decision makers to cost-effective therapeutic choices. Model assumptions were replaced with empirical data from a multipayer claim database and it was determined that model results overstated the cost-effectiveness of PPI-clarithromycin and understated the cost-effectiveness of bismuth-metronidazole-tetracycline (BMT).

Published in 2001

Piccirillo JF, Mager DE, Frisse ME, Brophy RH, Goggin A. Impact of first-line versus second-line antibiotics for the treatment of acute uncomplicated sinusitis. Journal of the American Medical Association 2001;286(15):1849-1856.

Acute sinusitis is one of the most common conditions for which patients seek medical attention. Previous studies suggest little benefit in relief of symptoms from the use of newer, more expensive second-line antibiotics over older, less expensive first-line antibiotics. These studies assessed relief of symptoms but failed to include other important endpoints such as development of complications and cost of care. The objective of this study was to determine if any incremental benefit of second-line antibiotics over first-line antibiotics for the treatment of acute uncomplicated sinusitis in adults exists and measure the cost between the two treatment regimens. Retrospective analysis of a large pharmaceutical database containing demographic, clinical (ICD-9 code), and treatment information for 29,102 adults with a diagnosis of acute sinusitis receiving initial antibiotic treatment between July 1, 1996 and June 30, 1997 was done. Treatment success was defined as the absence of any additional claims for an antibiotic in the 28 days after the initial antibiotic. Direct charges and utilization were determined for the acute sinusitis treatment episode. This study found there are no clinically significant differences in outcomes for patients with acute uncomplicated sinusitis treated with first-line or second-line antibiotics; however, cost of care is significantly higher for patients treated with second-line antibiotics.

Published in 2000

Grizzle AJ, Olson BM, Motheral BR, Armstrong EP, Abarca J, Cox ER. Therapeutic value: Who decides? Pharmaceutical Executive 2000;20(11):84,86,88,90.

Fairman KA, Motheral BR. Helicobacter pylori eradication in clinical practice: retreatment rates and costs of competing regimens. Annals of Pharmacotherapy 2000;34:721-728.

There is little consensus about optimal Helicobacter pylori eradication treatments. The purpose of this study was to measure Helicobacter pylori treatment outcomes through retrospective claims analysis. Patients treated from June 1, 1995 through May 31, 1996 were identified from an integrated medical/pharmacy claims database and followed until December 31, 1996. Patients were age 16 or older, continuously enrolled from April 1, 1996 through December 31, 1996, and treated with bismuth-based triple (N=98), proton pump inhibitor (PPI)-based triple (N=180), or PPI-based dual (N=337) regimens. Retreatment rates were higher for patients initially treated with PPI-based dual therapy than for patients treated with either of the triple therapies. Retreatment rates for patients treated with bismuth- versus PPI-based triple therapies did not significantly differ. Total and follow-up medical expenses were higher for retreated than non-retreated patients. Drug costs per successfully treated patient were $30 for bismuth-based, $172 for PPI-based triple, and $208 for PPI-based dual regimens. The study demonstrated that PPI-based dual regimens are not cost-effective in H pylori treatment. Further study is needed to compare more costly (PPI-based) versus less costly (bismuth-based) triple regimens.

Motheral BR, Grizzle AJ, Armstrong EP, Cox E, Fairman K. Role of pharmacoeconomics in drug benefit decision-making: Results of a survey. Formulary 2000;35:412-421.

The best measure of the value of pharmacoeconomic data is determining whether and how this information is being used in drug benefit decision-making activities. This survey of Formulary readers in managed care settings identifies their use of and views toward pharmacoeconomic studies, preferences for various types and sources of pharmacoeconomic information, and impact of such information on the actual drug benefit decision-making process. Some of the more interesting findings--published pharmacoeconomic studies showing short-term medical savings were rated the most important to drug benefit decision-making; unsolicited pharmacoeconomic information was deemed just as important as solicited information; and more modifications still need to be made in the ways pharmacoeconomic studies are conducted and distributed to make the results more applicable to users' needs.

Motheral BR, Cox ER, Daniels CE. Pharmacoeconomics and outcomes research, evaluating the studies. Journal of Managed Care Pharmacy January/February 2000;6 (suppl).

Penna P, Cox E, Joseph T, Lehman L, Morrow T, Richter A, Sowers J, Tepper D. Roundtable discussion: Part I - Epidemiologic, demographic, and treatment challenges in hypertension. Managed Care Interface 2000;Suppl C:10-16.

Penna P, Cox E, Joseph T, Lehman L, Morrow T, Richter A, Sowers J, Tepper D. Roundtable discussion: Part II - Development of a pharmacoeconomic model in hypertension. Managed Care Interface 2000;Suppl C:17-23.

Published in 1998

Fairman KA, Drevets WC, Kreisman JJ, Teitelbaum F. Course of antidepressant treatment, drug type, and prescriber's specialty. Psychiatric Services 1998; 49(9):1180-1186.

 

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