APCDs can Provide Important Insights for Surveilling the Opioid Epidemic, With Caveats

Buttorff, Christine; Wang, George S.; Tung, Gregory; Wilks, Asa; Schwam, Daniel; Pacula, Rosalie Liccardo

doi:10.1177/10775587211062382

Cited by 3 publications

(5 citation statements)

References 29 publications

(33 reference statements)

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“…Future studies should aim to capture immigration status and/or country of origin to better assess the prevalence of HBV/HDV among these populations. Recent discrepancies in pharmacy claims data have been noted when evaluating the APCD against local state-level databases 39 . The APCD captures prescription claims as opposed to prescription fills, which means out-of-pocket payments and/or claims from private insurers that are not required to report to the APCD are not represented.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and characteristics of hepatitis delta virus infection in patients with hepatitis B in the United States: An analysis of the All-Payer Claims Database

Gish,

Jacobson,

Lim

et al. 2023

Hepatology

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Background and Aims: Hepatitis delta virus (HDV) leads to the most severe form of viral hepatitis; however, the prevalence of HDV is not well understood. Using real-world data from the All-Payer Claims Database (APCD), this study estimates the prevalence of HBV/HDV infection among the chronic hepatitis B (HBV) population and describes patient/clinical characteristics for adults with HBV/HDV infection in the United States (US). Approach and Results: Adults (≥ 18 y) with ≥1 inpatient claim or ≥2 outpatient claims for HDV infection or HBV in the APCD from 1/1/2014 to 12/31/2020 were identified. HDV prevalence was calculated as the proportion of patients with HBV/HDV infection among total patients with HBV infection. Patient characteristics, socioeconomic status, advanced liver complications (e.g., cirrhosis, hepatocellular carcinoma), and comorbidities were assessed. A total of 6,719 -patients were diagnosed with HBV/HDV among 144,975 with HBV and 12-months of continuous data, for a prevalence of 4.6%. At diagnosis, 31.7% of patients with HBV/HDV had advanced liver complications, including compensated cirrhosis (16.3%) and decompensated cirrhosis (10.4%). Diabetes (50.5%), hypertension (49.8%), HIV infection (30.9%), were the top three comorbidities. Conclusion: In a large database capturing approximately 80% of the US insured population, HBV/HDV infection prevalence was 4.6% among HBV-infected adults. HDV-infected patients had high rates of baseline liver complications and other comorbidities at time of diagnosis, suggesting potentially delayed diagnosis and/or treatment. Earlier identification of HBV/HDV infection among the HBV population may provide opportunities to improve linkage to care and treatment, thereby reducing the risk of liver-related morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Prevalence and characteristics of hepatitis delta virus infection in patients with hepatitis B in the United States: An analysis of the All-Payer Claims Database

Gish,

Jacobson,

Lim

et al. 2023

Hepatology

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“…The information available in the CO-APCD is submitted by health insurers and includes pharmacy claims data. 10 , 11 The total spending on each generic, the number of claims, and the number of units of each drug dispensed in 2019 was obtained from the CO-APCD aggregated at the drug level. No patient or claims data were included in this study.…”

Section: Methodsmentioning

confidence: 99%

Estimating Savings Opportunities From Therapeutic Substitutions of High-Cost Generic Medications

Socal

Cordeiro²,

Anderson

et al. 2022

JAMA Netw Open

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ImportanceUse of generics is generally understood as a cost-saving practice. However, pharmacy benefit managers have an incentive to place higher-priced generic drugs on insurers’ drug formularies to profit by creating a large difference between the price negotiated with pharmacies and the price paid by insurers (what is known as spread pricing).ObjectiveTo examine price differentials and savings potential between high-cost generics and corresponding therapeutic alternatives of same clinical value and lower cost.Design, Setting, and ParticipantsThis cross-sectional analysis examined the top 1000 generics in Colorado’s all-payer claims database (CO-APCD) in 2019. High-cost generics and lower-cost generic therapeutic alternatives of same clinical value constituted the study sample. Data were analyzed from January 2019 to December 2019.ExposuresGeneric drug prices measured by transaction prices, average wholesale price (AWP), and national drug acquisition average cost (NADAC).Main Outcomes and MeasuresPrice differentials between the high-cost generics and the corresponding therapeutic alternatives. Levels of discounts and savings that could be achieved if the high-cost generics had been substituted by their therapeutic alternatives.ResultsThis cross-sectional study of the top 1000 CO-APCD generics identified 45 high-cost products that had lower-cost therapeutic alternatives of same clinical value. Overall, high-cost generics were 15.6 times more expensive than their therapeutic alternatives (median values). If the lower-cost alternatives had been used, total spending would have been reduced from $7.5 million to $873 711, resulting in 88.3% savings. Most substitutions (28 of 45 [62.2]%) involved different dosage forms or different strengths of the same drug and provided mean (SD) discounts of 94.9% (3.8%) and 77.1% (19.9%), respectively.Conclusions and RelevanceIn this study, replacing high-cost generics with lower-cost alternatives of same clinical value would produce savings of nearly 90%. Plan sponsors should be aware that some generics are associated with higher spending and should periodically review the specific products driving their generic drug spending. Substitution of high-cost generics may provide a simple pathway to offer the same therapeutic benefit at lower cost to patients and insurers.

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“…Colorado creates longitudinal identifiers for each patient to allow tracking of patients over time and across insurance payers. Linking APCDs to cancer or other registries may be applicable to other states and conditions where registry and cohort data exist and can be linked to claims data 9,19–21 …”

mentioning

confidence: 99%

“…Linking APCDs to cancer or other registries may be applicable to other states and conditions where registry and cohort data exist and can be linked to claims data. 9,[19][20][21] We describe the process of linking both data sources over multiple years and assess the challenges of using these data while demonstrating the potential role of APCDs in supporting patient-centered economic outcomes research. Prior published studies have discussed treatment completeness in cancer registry and APCD linkages, highlighting the role of the APCD in augmenting information beyond the initial course of treatment.…”

mentioning

confidence: 99%

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Building Data Infrastructure for Disease-Focused Health Economics Research

Bradley,

Liang,

Lindrooth

et al. 2023

Medical Care

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Background: Data infrastructure for cancer research is centered on registries that are often augmented with payer or hospital discharge databases, but these linkages are limited. A recent alternative in some states is to augment registry data with All-Payer Claims Databases (APCDs). These linkages capture patient-centered economic outcomes, including those driven by insurance and influence health equity, and can serve as a prototype for health economics research. Objectives: To describe and assess the utility of a linkage between the Colorado APCD and Colorado Central Cancer Registry (CCCR) data for 2012–2017. Research Design, Participants, and Measures: This cohort study of 91,883 insured patients evaluated the Colorado APCD-CCCR linkage on its suitability to assess demographics, area-level data, insurance, and out-of-pocket expenses 3 and 6 months after cancer diagnosis. Results: The linkage had high validity, with over 90% of patients in the CCCR linked to the APCD, but gaps in APCD health plans limited available claims at diagnosis. We highlight the advantages of the CCCR-APCD, such as granular race and ethnicity classification, area-level data, the ability to capture supplemental plans, medical and pharmacy out-of-pocket expenses, and transitions in insurance plans. Conclusions: Linked data between registries and APCDs can be a cornerstone of a robust data infrastructure and spur innovations in health economics research on cost, quality, and outcomes. A larger infrastructure could comprise a network of state APCDs that maintain linkages for research and surveillance.

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APCDs can Provide Important Insights for Surveilling the Opioid Epidemic, With Caveats

Cited by 3 publications

References 29 publications

Prevalence and characteristics of hepatitis delta virus infection in patients with hepatitis B in the United States: An analysis of the All-Payer Claims Database

Prevalence and characteristics of hepatitis delta virus infection in patients with hepatitis B in the United States: An analysis of the All-Payer Claims Database

Estimating Savings Opportunities From Therapeutic Substitutions of High-Cost Generic Medications

Building Data Infrastructure for Disease-Focused Health Economics Research

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