Effect of 6 Managed Care Pharmacy Tools: A Review of the Literature

doi:10.18553/jmcp.2010.16.s6-a.1

Cited by 20 publications

(11 citation statements)

References 54 publications

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“…As future annual care costs may be offset by insurance premium payments in the US and general taxation and national insurance payments in the UK, there is a reasonable question as to how these should be applied from a payer perspective. Guidelines from the National Institute for Health and Care Excellence (NICE) and Academy of Managed Care Pharmacy (AMCP) do not specify a time horizon to use ( 36 , 37 ), but note that the time horizon implemented should be sufficient to capture “the period over which the main differences in health effects and use of healthcare resources between interventions are expected to be experienced” ( 36 ). As all patients are off mechanical ventilation and out of the hospital setting at 1 year, a short time horizon may be appropriate for decision makers.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Cost-Effectiveness of Proportional-Assist Ventilation Plus vs. Pressure Support Ventilation in the Intensive Care Unit in Two Countries

Saunders

Geogopoulos

2018

Front. Public Health

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Background: Mechanical ventilation is an integral, but expensive, part of the intensive care unit (ICU). Optimal use of mechanical ventilation could save costs and improve patient outcomes. Here, the cost effectiveness of proportional assist ventilation (PAV™ ventilation by Medtronic) is estimated relative to pressure support ventilation (PSV).Methods: A cohort-level, clinical model was built using data from clinical trials. The model estimates patient-ventilator asynchrony >10%, tracheostomy, ventilator-associated pneumonia, other nosocomial infections, spontaneous breathing trial success, hypoxemia, and death. Cost and quality of life are associated with all events, with cost effectiveness defined as the cost per quality-adjusted life year (QALY) gained in the US and UK.Results: The mean cost of ICU care was lower with PAV™ than with PSV in the US and UK, but the total cost of care over 40 years was higher due to more patients surviving and incurring future care costs. Reduced time on mechanical ventilation, fewer nosocomial infections, and extended life expectancy with PAV™ drove QALY improvement. The cost per QALY gained with PAV™ was $8,628 and £2,985.Conclusion: PAV™ improves quality of life and reduces short-term costs. PAV™ is likely to be considered cost-effective over 40-years in the US and UK.

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Section: Discussionmentioning

confidence: 99%

Evaluating the Cost-Effectiveness of Proportional-Assist Ventilation Plus vs. Pressure Support Ventilation in the Intensive Care Unit in Two Countries

Saunders

Geogopoulos

2018

Front. Public Health

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“…11 Some studies have reported a negative impact of ST policies on outcomes, such as treatment discontinuation and decreased medication adherence. [12][13][14] Despite some recent publications regarding ST impacts, limited evidence exists in regard to ST impacts on utilization and costs in other therapy areas and in the Medicare population in particular. [11][12][13] In the OAB therapy area, Humana had implemented ST formulary policies across Medicare plans that required treatment with 2 antimuscarinic medications (including oxybutynin and trospium) prior to approval of a prescription claim for 2 branded products, fesoterodine and mirabegron.…”

Section: ■■ Methods Study Designmentioning

confidence: 99%

Impact of Overactive Bladder Step Therapy Policies on Medication Utilization and Expenditures Among Treated Medicare Members

Abbass¹,

Caplan²,

et al. 2017

JMCP

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This research was funded by Astellas Pharma Global Development and was conducted as part of the Astellas-Humana Research Collaboration. Ng, Kristy, Schermer, and Bradt are employees of Astellas. Astellas manufactures mirabegron (Myrbetriq) and solifenacin (VESIcare). Abbass, Caplan, Collins, and Suehs are employees of Comprehensive Health Insights, a subsidiary of Humana, which received funding from Astellas for this study. Suehs owns stock in Humana. Chan is an employee of Humana Pharmacy Solutions. Portions of this study were presented as a poster at Academy of Managed Care Pharmacy Nexus 2015; October 26-29, 2015; Orlando, Florida. Study concept and design were contributed by Ng, Chan, Suehs, and Abbass, along with Collins. Abbass took the lead in data collection, along with Collins and with assistance from Caplan, Chan, and Suehs. Data interpretation was provided by Kristy and Bradt, along with Abbass, Caplan, Ng, Suehs, Collins, and Chan. The manuscript was written primarily by Caplan, along with Schermer, Suehs, and Abbass, and revised by Caplan, Schermer, and Ng, along with the other authors.

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“…For each scenario and each year of the 3-year projection period, total undiscounted annual LMT medication, dispensing and healthcare costs, including the costs of CV events, were estimated for all prevalent patients in the target population. The model was developed in Microsoft Excel 2007 (Microsoft Corporation, Redmond, WA, USA) and complied with recommendations of the Academy of Managed Care Pharmacy Format for Formulary Submissions [ 43 ] and the International Society for Pharmacoeconomics and Outcomes Research Principles of Good Practice for Budget Impact Analysis [ 42 ].…”

Section: Methodsmentioning

confidence: 99%

Budget Impact Analysis of PCSK9 Inhibitors for the Management of Adult Patients with Heterozygous Familial Hypercholesterolemia or Clinical Atherosclerotic Cardiovascular Disease

et al. 2017

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ObjectiveThe aim of this study was to assess the budget impact of introducing the proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) alirocumab and evolocumab to market for the treatment of adults with heterozygous familial hypercholesterolemia or clinical atherosclerotic cardiovascular (CV) disease requiring additional lowering of low-density lipoprotein cholesterol (LDL-C).MethodsA 3-year model estimated the costs of lipid-modifying therapy (LMT) and CV events to a hypothetical US health plan of 1 million members, comparing two scenarios—with and without the availability of PCSK9i as add-on therapy to statins. Proportions of patients with uncontrolled LDL-C despite receiving statins, and at risk of CV events, were estimated from real-world data. Total undiscounted annual LMT costs (2017 prices, including PCSK9i costs of $14,563.50), dispensing and healthcare costs, including the costs of CV events, were estimated for all prevalent patients in the target population, based on baseline risk factors. Maximum PCSK9i utilization of 1–5% over 3 years according to risk group (following the same pattern as current ezetimibe use), and 5–10% as a secondary scenario, were assumed.ResultsTotal healthcare budget impacts per target patient (and per member) per month for years 1, 2 and 3 were $3.62($0.10), $7.22($0.20) and $10.79($0.30), respectively, assuming 1–5% maximum PCSK9i utilization, and $15.81($0.44), $31.52($0.88) and $47.12($1.31), respectively, assuming 5–10% utilization. Results were sensitive to changes in model timeframe, years to maximum PCSK9i utilization and PCSK9i costs.ConclusionsThe budget impact of PCSK9i as add-on therapy to statins for patients with hypercholesterolemia is relatively low compared with published estimates for other specialty biologics. Drug cost rebates and discounts are likely to further reduce budget impact.Electronic supplementary materialThe online version of this article (10.1007/s40273-017-0590-5) contains supplementary material, which is available to authorized users.

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Effect of 6 Managed Care Pharmacy Tools: A Review of the Literature

Cited by 20 publications

References 54 publications

Evaluating the Cost-Effectiveness of Proportional-Assist Ventilation Plus vs. Pressure Support Ventilation in the Intensive Care Unit in Two Countries

Evaluating the Cost-Effectiveness of Proportional-Assist Ventilation Plus vs. Pressure Support Ventilation in the Intensive Care Unit in Two Countries

Impact of Overactive Bladder Step Therapy Policies on Medication Utilization and Expenditures Among Treated Medicare Members

Budget Impact Analysis of PCSK9 Inhibitors for the Management of Adult Patients with Heterozygous Familial Hypercholesterolemia or Clinical Atherosclerotic Cardiovascular Disease

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