n=25), wholesaler acquisition cost (WAC, n=11) and combination AWP/WAC (n=10). We found no statistical significant relationship between the number of claims or the total state expenditures, and the dispensing fee or ingredient cost. CONCLUSIONS: Dispensing fees and ingredient cost varied among the different states' Medicaid programs. Those differences were not related to the total utilization and expenditures of the state programs. Appropriate reimbursement and dispensing fee policies encouraging generic utilization could result in substantial saving for the Medicaid program. OBJECTIVES:As the health care safety net continues to grow in both depth and breadth, the provider payment system will play an increasing role in the resource allocation of health care in China. This paper is intended to assess the primary effects of payment reform of capitation experiment and the supplementary open enrollment policy in Changde city, China. METHODS: In October 2007, Changde employed a capitation approach to pay for health care under the Urban Resident Basic Medical Insurance (URBMI), while the fee-forservice approach was still used by the Urban Employee Basic Medical Insurance (UEBMI) in the city and other programs as well. Using the national URBMI Household Panel Survey from 2008-2010, we conducted a set of difference-indifference (DD) models to assess the capitation policy effect on cost and utilization outcomes while controlling for other differences between Changde and other cities. RESULTS: The study finds the payment reform to reduce its inpatient out-of-pocket cost by 19.7%, out-of-pocket ratio by 9.5%, and length of stay by 17.5%. The total inpatient cost, drug cost ratio, treatment effect, and patient satisfaction showed little difference between FFS and capitation models. The robust tests find the relatively poor health subsample present a similar pattern with the results based on the full sample; as for the population cohort with good and very good self-rated health conditions, the payment reform in Changde has little impact on either providers or patients. CONCLUSIONS: We conclude that the payment reform in Changde led to an decrease in the financial burden of patients for inpatient care and improve hospital efficiency, without compromising quality of care. The total cost measures remain no change between capitation and FFS settings, which can be research topics for further studies concerning the long term effect of capitation approaches.

OBJECTIVES:To determine the cost-effectiveness relation of adding Saxagliptin to Metformin therapy (SAXAϩMET) compared to adding Sulfonylureas (SULFϩMET), in patients with type 2 diabetes mellitus (DM2) who have failed to achieve adequate glycemic control with metformin. METHODS: A discrete event simulation model (Cardiff long term cost-utility model) with a fixed time increase based on UKPDS 68 was used to simulate disease progression and to obtain an estimate of the treatment's economic and health consequences in DM2 patients. Clinical efficacy parameters for Saxagliptin were obtained from the literature; drug acquisition costs, adverse events (AEs) and microvascular and macrovascular complications were taken into account. The time horizon was 20 years and the perspective was that of the public health care system in Chile. Costs were expressed in US dollars (2009), with an annual 3.5% discount. RESULTS: A lower number of non-fatal events were found for the SAXAϩMET-treated group versus the SULFϩMET-treated group. Additionally, the model predicted a lower number of fatal macrovascular (132.3 vs. 136.0) and microvascular (19.6 vs. 19.7) events for the SAXAϩMET-treated group vs. the SULFϩMET-treated group. The total cost of the SAXAϩMET cohort was lower than the SULFϩMET cohort: US$ 15.006.011 and U$S 14.557.581, respectively. Treatment with SAXAϩMET resulted in a higher number of QALYs (9,794 vs. 9,594) and LYs (23,068 vs. 23,019) for the 1000 patients' cohort than treatment with SULFϩMET; the incremental analysis per QALY and LY gained was -US$2,243 and US$ Ϫ9,182 respectively (dominant). CONCLUSIONS: Results suggest that the addition of Saxagliptin to metformin therapy is dominant compared to the addition of sulfonylureas; therefore, this intervention would represent an efficient use of health resources for DM2 patients in Chile.

OBJECTIVES: Non-adherence to a prescribed therapeutic program is an issue in the treatment of chronic diseases more so for asthma, in which the lack of symptoms may be interpreted as remission and beliefs about inhaled corticosteroid (ICS) could also result in non-adherence. The objective of the study was to analyse the self-reported adherence to ICS therapy and beliefs about medicine. METHODS: Adult patients previously diagnosed with asthma and who were prescribed ICS, visiting emergency room of a tertiary care public chest hospital for asthma exacerbation were recruited (March 2008-December 2009. Patients completed self-reported questionnaire containing 49 questions on six domains: socio-demographic, clinical profile, causal belief, self-report on adherence, beliefs about medicines and medication adherence report scale (MARS) after stabilization. RESULTS: Of the 200 patients, 51.5% were between 30-40 years, 64% were female, mean duration of asthma was 10.5Ϯ8.1 years and 51.5% were having severe asthma. Salient findings on self-report adherence were, 49% reported that they took ICS even if asymptomatic; 91% reported that they forgot to take their ICS some or most of the times; 84% reported that they avoided ICS some of the times. In response to individual item for MARS, 15.5% claimed that they took ICS as prescribed. Significant positive correlation was observed between treatment necessity and reported adherence (rϭ0.445, p Ͻ 0.001). Patients who were concerned for the potential effects and risk of dependence had low adherence with significantly negative correlation. Younger age group had a significant correlation with social inhibition and female gender correlated significantly with fear of adverse effects and social inhibition as the cause for avoiding ICS. CONCLUSIONS: The findings support the model of treatment adherence, which incorporated beliefs about treatment as well as illness perceptions. The necessary-concerns offer a potentially useful framework to help clinicians elicits key treatment beliefs influencing adherence to ICS.

Non-adherence to a prescribed therapeutic program is an issue in the treatment of chronic diseases more so for asthma, in which the lack of symptoms may be interpreted as remission and beliefs about inhaled corticosteroid (ICS) could also result in non-adherence. The objective of the study was to analyse the self-reported adherence to ICS therapy and beliefs about medicine. METHODS: Adult patients previously diagnosed with asthma and who were prescribed ICS, visiting emergency room of a tertiary care public chest hospital for asthma exacerbation were recruited (March 2008-December 2009). Patients completed self-reported questionnaire containing 49 questions on six domains: socio-demographic, clinical profile, causal belief, self-report on adherence, beliefs about medicines and medication adherence report scale (MARS) after stabilization. RESULTS: Of the 200 patients, 51.5% were between 30-40 years, 64% were female, mean duration of asthma was 10.5Ϯ8.1 years and 51.5% were having severe asthma. Salient findings on self-report adherence were, 49% reported that they took ICS even if asymptomatic; 91% reported that they forgot to take their ICS some or most of the times; 84% reported that they avoided ICS some of the times. In response to individual item for MARS, 15.5% claimed that they took ICS as prescribed. Significant positive correlation was observed between treatment necessity and reported adherence (rϭ0.445, p Ͻ 0.001). Patients who were concerned for the potential effects and risk of dependence had low adherence with significantly negative correlation. Younger age group had a significant correlation with social inhibition and female gender correlated significantly with fear of adverse effects and social inhibition as the cause for avoiding ICS. CONCLUSIONS: The findings support the model of treatment adherence, which incorporated beliefs about treatment as well as illness perceptions. The necessary-concerns offer a potentially useful framework to help clinicians elicits key treatment beliefs influencing adherence to ICS.

The objective of this research is to evaluate the cost-effectiveness of linezolid 600mgBID(LI), vancomycin 1gBID(VA) and teicoplanin 400mgBID(TE) in the treatment of nosocomial pneumonia caused by MRSA under the public health care system perspective. METHODS: To compare the options, a decision tree model was built considering an arm per treatment option, from which patients could respond to the initial treatment and continue to a maintenance treatment using the same antibiotics, or do not respond, and repeat the treatment with assumed 50% chance to use one of the other two antibiotics. Clinical or microbiological effectiveness could be used as determinants of response. Effectiveness measures were mortality, clinical and microbiological responses, calculated by an indirect comparison of a literature systematic review. Hospitalization days were evaluated. Only direct costs were considered, and were obtained from DATASUS/SIGTAP 2012 for medical procedures, and DATASUS/BPS considering the average of purchases from November 2011 to October 2012 for medications and materials, as the latest data available. Values were represented in 2012USD. A time horizon of 1 year was considered. RESULTS: Clinical response rates were 66.5%(VA), 68.3%(TE), 72.6%(LI), microbiological response rates were 56.1%(VA), 55.9%(TE), 64.4%(LI), mortality rates were 15.74%(VA), 13.56%(TE), 10.13%(LI). If clinical response was considered as a determinant of success, the treatment costs would be 13,806.58USD(VA), 14,279.01USD(TE), 15,301.44USD(LI), hospitalization days would be 41(VA), 39(TE), 26(LI), and if microbiological response was considered, the treatment costs would be 14,637.39USD(VA); 15,169.33USD(TE), 15,793.21USD(LI) and hospitalization days would be 42(VA), 40(TE), 28(LI). Incremental costeffectiveness ratios for TE and LI when compared to VA for clinical response were 26,246.03USD, 24,505.90USD, and for microbiological response were -26,597.03USD(dominated), 13,925.46USD respectively. CONCLUSIONS: Assuming a willingness to pay of 32,621.93USD (3 times Brazilian 2011GDP per capita), linezolid was the most cost-effective option compared to vancomycin, additionally presenting lower mortality and less hospitalization days at public health care services.