Industry Research

Population Health and Pharmaceuticals

Published in 2004

Cox ER, Frisse M, Behm A, Fairman KA. Over-the-Counter Pain Reliever and Aspirin Use Within a Sample of Long-term Cyclooxygenase 2 Users. Archives of Internal Medicine. June 14, 2004;164:1243-1246.

The purpose of this study was to estimate the comedication rates for aspirin, ibuprofen, acetaminophen, and naproxen sodium among long-term COX-2 users. A telephone survey was used to measure comedication use. The survey was administrated by nurses trained in survey administration. Members were asked about their use of COX2s and over-the-counter (OTC) agents over the past 30 days, the number of days they took each agent, the dose or strength of each agent, and, for those taking aspirin, the reason for use.. Study results show a high rate of comedication with aspirin for cardioprotection (99%), and a sizeable percentage of comedication with OTC pain reliever (76%). These patterns of behavior have implications for patient GI safety and may suggest the need for better pain management.

Delate T, Gelenberg AJ, Simmons VA, Motheral BR. Trends in the Use of Antidepressant Medications in a Nationwide Sample of Commercially Insured Pediatric Patients, 1998-2002. Psychiatric Services. 2004;55(4):387-391.

The purpose of this study was to determine contemporary estimates of the prevalence of ambulatory antidepressant medication (ADM) use in commercially insured children and adolescents. Results indicated that the growth in the prevalence of ADM use in these populations appears to be continuing, similar to that seen earlier in the era of the second-generation ADMs.

Published in 2003

Cox ER, Motheral BR, Frisse M, Behm A, Mager D. Prescribing COX-2s for Patients New to Cyclo-oxygenase Inhibition Therapy. The American Journal of Managed Care. 2003;9(11):735-742.

The purpose of this study was to evaluate cyclo-oxygenase 2 inhibitor (COX-2) prescribing and utilization - specifically length of therapy, medical conditions treated, and gastrointestinal (GI) risk profile of users. A descriptive retrospective analysis was performed using medical and prescription claims data from a large preferred provider organization (PPO) located in the Midwest. Targeted patients were continuously eligible during the study period, at least 18 years of age, and new to COX-2 therapy. Patients were evaluated for one year prior to and after their first COX-2 prescription. Results showed the length of therapy was highly skewed, with a mean of 116 days (standard deviation (SD)=119.5) and a median of 60 days. The most common medical conditions associated with COX-2 use included a variety of musculoskeletal conditions such as low back pain (22%) and osteoarthritis (18%). Approximately, 19% of patients did not have a diagnoses associated with COX-2 therapy, 65% did not have an indication of being at risk for GI events, and 68% had no indication for trying a lower-cost nonselective nonsteroidal anti-inflammatory drug (NSAID) prior to beginning COX-2 therapy. Overall, 45% did not have a GI risk factor or prior use of nonselective NSAID therapy. Findings suggest that opportunities exist to encourage the cost-effective prescribing of COX-2 therapy through programs such as Step Therapy or Prior Authorization.

Cox ER, Motheral BR, Henderson RR, Mager D. Geographic Variation in the Prevalence of Stimulant Medication Use Among Children 5 to 14 Years Old: Results From a Commercially Insured US Sample. Pediatrics 2003;111(2):237-243.

This study evaluated geographic variation in the use of stimulant medications in a sample of commercially insured children age 5 to 14 years. This study also evaluated other factors thought to influence the use of stimulants in children including age, gender, income, and urban/rural residence. The study found significant variation in use of stimulants across geographic regions, with higher use in the South and Midwest regions, compared to the Western region of the country.

Roe CM, Odell KW, Henderson RR. Concomitant Use of Antipsychotics and Drugs That May Prolong the QT Interval. Journal of Clinical Psychopharmacology 2003;23(2):197-200.

The purpose of this study was to compare the concomitant use of drugs that may prolong the QT interval. One group of patients used antipsychotics that may prolong QT prolongation and one group of patients used antipsychotics that do not prolong the QT interval. This study indicated there was no significant difference between the two groups with concomitant use of other QT drugs when potential confounders were controlled.

Published in 2002

Roe CM, McNamara AM, Motheral BM. Gender- and age-related prescription drug use patterns. The Annals of Pharmacotherapy 2002;36:30-39.

This study provides the first consolidated summary of gender- and age-related prescription drug utilization patterns among a large and diverse, commercially insured population within the U.S. The top fifteen prescription drug categories used by males and females at different ages are reported and compared to national prevalence data for diseases for which medications are an integral part of the treatment plan or therapeutic intervention. Various results include that most gender differences in medication use appear after or around the puberty years. Also, women are more likely to use several classes of medications, including antidepressants and antianxiety and pain medications. Analysis of data from the epidemiologic literature suggests that the gender differences in medication use shown in this study generally are to be expected.

Motheral BM, Cox ER, Mager DE, Henderson RR. Prescription Drug Atlas.
Available on the Express Scripts Website

This study is the first comprehensive state-by-state study of prescription drug use. Age and gender have always been among the best indicators of prescription drug use, but results from this study show that where one lives is also a good indicator of which and how many medications one uses. Prescription drug use was tracked for a random sample of commercially insured members who were continuously enrolled throughout 2000. Results showed that generally prescription drug use was lower in the Northeast and West, and higher in the South and Midwest. Even greater variation was found upon examination of prevalence of prescription drug use for 23 of the most commonly prescribed therapy categories. The study also observed prescription use for children and found that overall, children exhibited greater variation than adults for most therapy classes.

Published in 2001

Cox ER, Roe C. Prescription use among a commercially insured senior population, 1998: Express-Scripts, May 2001.
Available on the Express Scripts Website

This study reports on prescription drug use among a commercially insured population 65 years of age and older. The report profiles the proportion of members using the benefit ('users'), the per-member-per-year (PMPY) number of prescriptions and total expenditures, the top therapeutic categories utilized, overall and by age group and gender. The data for this study came from the 1998 Express Scripts Master Analytical Database (MAD98) and profiles prescription use on over 52,000 senior members. The report underscores the high cost of providing prescription coverage and the complexity of prescription use among a population over the age of 65. In 1998, individuals consumed on average, 29 (median = 20) 30-day equivalent prescriptions at an annual expense of $1,185 (median = $662). Overall, 76 percent of members used the prescription benefit at least once during the year. Of the top ten therapy categories ranked by use, five are used to treat cardiovascular disease: antihypertensive agents, antihyperlipidemics, diuretics, calcium channel blockers and beta blockers. These five therapy categories represent 35 percent of all prescription claims. The report highlights the complexity of prescription use among those 65 years of age and older and discusses implications for clients as well as steps that clients can take to help mitigate unwanted effects of drug therapy in the elderly.

Published in 2000

Fairman KA. The effect of new and continuing prescription drug use on cost: a longitudinal analysis of chronic and seasonal utilization. Clinical Therapeutics 2000;22:641-652.

Prescription drug costs are rising rapidly, but there is little agreement on appropriate cost-containment strategies. The purpose of this study was to assess utilization trends and product selection. The study followed 463,820 continuously enrolled adult utilizers of 15 chronic or seasonal therapeutic classes for 2½ years (January 1996 to June 1998). Outcome measures included utilization rates, the relationship between new use and utilization growth, and product mix (selection of drugs within therapeutic class). Utilization growth rates varied substantially by class. The highest two-year utilization rate change was 66.7% for antihyperlipidemics; change was < 10% in only 3 classes. Utilization growth depended heavily on treatment continuation. In most classes, product mixes for new and continuing users were comparable. In some classes, however, both new and continuing users increased their use of newer, more expensive products. Cost-containment strategies should address differences among therapeutic classes. Further research should assess the costs and benefits of rapid utilization growth in certain classes.

Fairman KA. Comment on "Variations in medication compliance related to individual drug, drug class, and prescribing physician." Journal of Managed Care Pharmacy 2000;6:100-101.

The publication of a recent article about medication compliance raises concerns. The study's lack of eligibility information and failure to develop an adequate provider database are serious methodological flaws. The study's primary outcome measure of compliance showed little variation, most likely because patients terminating therapy prematurely were excluded from the sample, limiting the study population to a small subgroup of medication users. Outcomes researchers must dig a little deeper - identify appropriate databases, redesign a study when the initial design proves inappropriate, and use multivariate techniques when descriptive analyses lead to substantial unanswered questions - in order to give the outcomes research field the best possible chance to inform health care policy.

Roe CM, Motheral BR, Teitelbaum F, Rich MW. Compliance with and dosing of angiotensin-converting-enzyme inhibitors before and after hospitalization. American Journal of Health-System Pharmacy 2000;57:139-145.

Adequate compliance and dosing are important in preventing hospitalizations for heart failure. The purpose of this study was to examine use of, compliance with, and dosing of angiotensin-converting-enzyme (ACE) inhibitors before and after hospitalization for heart failure. The study followed 236 patients hospitalized with heart failure. Compliance with and use and dosing of ACE inhibitors were examined over the 180-day period before admission and the 180-day period after discharge using an integrated pharmacy and medical claims database. Before hospitalization, 109 patients (46.2%) used ACE inhibitors; after hospitalization, 148 (62.7%) used them-a significant increase. Counterintuitively, compliance decreased after hospitalization. Dosing increased from 72% to 85% of an adequate daily dose after hospitalization among patients who took ACE inhibitors during both the prehospitalization and posthospitalization periods. However, almost one-third of hospitalized patients stopped taking their ACE inhibitor within six months of hospital discharge. Compliance and dosing of ACE inhibitors before and after hospitalization need to be improved.

Published in 1999

Roe CM, Motheral BR, Teitelbaum F, Rich MW. Angiotensin-converting enzyme inhibitor compliance and dosing among patients with heart failure. American Heart Journal 1999;138:818-825.

Published in 1997

Fairman KA, Teitelbaum F, Drevets WC, Engquist G, Kreisman JJ, Norusis MJ. Course of antidepressant treatment with tricyclic versus selective serotonin reuptake inhibitor agents: A comparison in managed care and fee-for-service environments. American Journal of Managed Care 1997; 3(3): 453-465.

 

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