Journal of managed care & specialty pharmacy最新文献

{"title":"Dose escalation of biologics in biologic-naive patients with Crohn's disease: Outcomes from the ODESSA-CD study.","authors":"Noa Krugliak Cleveland, Sabyasachi Ghosh, Niranjan Kathe, Kandavadivu Umashankar, Kirti Mirchandani, Arunima Hait, Riyanka Paul, Ninfa Candela, Tao Fan, David T Rubin","doi":"10.18553/jmcp.2024.30.11.1276","DOIUrl":"10.18553/jmcp.2024.30.11.1276","url":null,"abstract":"<p><strong>Background: </strong>Dose escalation of biologics may restore response in patients with Crohn's disease (CD) who experience inadequate response or loss of response, but the rates of dose escalation and subsequent adverse clinical outcomes have not been well characterized.</p><p><strong>Objective: </strong>To evaluate the rate of dose escalation of biologics and associated adverse clinical outcomes and economic outcomes in biologic-naive patients with CD.</p><p><strong>Methods: </strong>ODESSA-CD (real wOrld Dose EScalation and outcomeS with biologics in IBD pAtients with Crohn's Disease) was a retrospective cohort study conducted using claims data from IBM MarketScan databases. Adults with CD with at least 1 claim for an index drug (adalimumab, infliximab, ustekinumab, or vedolizumab) between January 1, 2017, and December 31, 2018, and no claims for biologics in the 6 months prior (ie, biologic naive) were included. Follow-up ended on June 30, 2020. Cox proportional hazards models and logistic regression models were used to compare the rate of dose escalation and the likelihood of adverse clinical outcomes and costs after dose escalation, respectively.</p><p><strong>Results: </strong>Of the 2,664 eligible patients, most (71.4%) were younger than 50 years and 50.5% were male. The rate of dose escalation was higher with the anti-tumor necrosis factor α (TNFα) treatments adalimumab (hazard ratio [HR] = 1.703; <i>P</i> < 0.0001) and infliximab (HR = 1.690; <i>P</i> < 0.0001) compared with vedolizumab, but there was no significant difference between ustekinumab and vedolizumab (HR = 0.842; <i>P</i> = 0.730). After dose escalation, the likelihood of infection, sepsis, and inflammatory bowel disease-related hospitalization did not differ among biologics (anti-TNFα vs vedolizumab: odds ratio [OR] = 1.141, <i>P</i> = 0.599; ustekinumab vs vedolizumab: OR = 0.891; <i>P</i> = 0.836); however, corticosteroid use was more likely with anti-TNFα treatment than with vedolizumab (OR = 1.740, <i>P</i> = 0.002). Among patients whose dose was escalated, index drug costs were likely to be higher with anti-TNFα treatment and ustekinumab than with vedolizumab (anti-TNFα vs vedolizumab: ratio of expected cost = 1.429, <i>P</i> = 0.002; ustekinumab vs vedolizumab: ratio of expected cost = 3.115, <i>P</i> < 0.0001).</p><p><strong>Conclusions: </strong>Patients who were biologic naive and received ustekinumab or vedolizumab were less likely to undergo dose escalation than those who received anti-TNFα treatment. Adverse clinical outcomes after dose escalation were similar among these biologics but with different costs. These analyses may inform providers and payers of the clinical and economic implications of dose escalation.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"30 11","pages":"1276-1287"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic burden of recurrent hyperkalemia in patients with chronic kidney disease.","authors":"George Bakris, Abiy Agiro, Alexandra Greatsinger, Fan Mu, Erin E Cook, Manasvi Sundar, Elaine Louden, Ellen Colman, Pooja Desai","doi":"10.18553/jmcp.2024.24114","DOIUrl":"10.18553/jmcp.2024.24114","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Hyperkalemia is a common complication of chronic kidney disease (CKD) and can become recurrent in half of cases. However, the incremental economic burden associated with recurrent hyperkalemia is unknown.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate all-cause health care resource utilization (HRU) and medical costs in patients with stage 3/4 CKD with recurrent hyperkalemia vs normokalaemia and vs nonrecurrent hyperkalemia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data were from Optum's de-identified Market Clarity Data (January 1, 2016, to August 1, 2022). This retrospective observational cohort study compared patients with stage 3/4 CKD with recurrent hyperkalemia (≥2 hyperkalemia events within 1 year [hyperkalemia event: hyperkalemia diagnosis or potassium [K+]&gt;5 mmol/l]; index was the first hyperkalemia event) with an exact- and propensity score-matched cohort of patients with normokalemia (K+ ≥3.5 to ≤5 mmol/l; random K+ as index) and separately with a matched cohort of patients with nonrecurrent hyperkalemia (1 hyperkalemia event within 1 year; index was hyperkalemia event). Patient characteristics, medication use, HRU, and medical costs were compared between cohorts using standardized mean differences during the 12-month baseline period. All-cause HRU and medical costs during the 12-month follow-up were compared using Wilcoxon rank sum tests for continuous variables and McNemar tests for categorical variables. Substudies of recurrent hyperkalemia vs normokalemia were conducted for patients with Medicare coverage and renin-angiotensin-aldosterone system inhibitor (RAASi) use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The recurrent hyperkalemia vs normokalemia sample comprised 4,549 matched pairs (Medicare substudy: 3,151; RAASi substudy: 3,535) and the recurrent hyperkalemia vs nonrecurrent hyperkalemia sample comprised 1,599 matched pairs. Baseline characteristics, HRU, and medical costs of the cohorts were similar after matching. During follow-up, patients with recurrent hyperkalemia had a mean of 11.2 more health care encounters (0.5 more inpatient admissions, 0.3 more emergency department visits, and 7.2 more outpatient visits) than patients with normokalemia. Patients with recurrent hyperkalemia also had double the total annual medical costs vs normokalemia ($34,163 vs $15,175; &lt;i&gt;P&lt;/i&gt; &lt; 0.001), mainly driven by inpatient costs ($21,250 vs $7,392), which accounted for 62.2% and 48.7% of total costs, respectively. Results were similar in the RAASi and Medicare substudies. Recurrent hyperkalemia was associated with a mean 4.3 more all-cause health care encounters and $14,057 higher medical costs (both &lt;i&gt;P&lt;/i&gt; &lt; 0.001) than nonrecurrent hyperkalemia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Recurrent hyperkalemia in patients with stage 3/4 CKD was associated with higher all-cause HRU and medical costs compared with normokalemia (including in patients with Medicare coverage and RAASi use) and nonrecurrent hyperkalemia. Research i","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"1261-1275"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of discontinuing disease-modifying therapies on health care utilization among midlife patients with multiple sclerosis in the United States.","authors":"Yiran Qian, Carolyn T Thorpe, Casey Tak, Stephanie Iyer, Amanda Seyerle, Joshua M Thorpe","doi":"10.18553/jmcp.2024.30.11.1248","DOIUrl":"10.18553/jmcp.2024.30.11.1248","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Multiple sclerosis (MS) is a lifelong progressive neurological disease treated primarily with disease-modifying therapies (DMTs). Disease activity tends to decline as patients age. Midlife represents a crossroads where the risks of DMT may outweigh the benefits, prompting providers to consider DMT discontinuation to reduce treatment burden. However, real-world evidence on the impact of DMT discontinuation among midlife patients is lacking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the association between DMT discontinuation and health care utilization among midlife patients with MS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Midlife patients with MS who received an injectable or oral DMT between 2001 and 2018 were identified from the MarketScan commercial claims database. DMT discontinuation, defined as a treatment gap exceeding 90 days in days supply, was the independent variable. Patients who discontinued DMTs had their index date set as the last gap day, whereas index dates for those who continued DMTs were matched based on the time distribution of index dates of discontinuers. Inpatient hospitalizations (all-cause, MS-related, and non-MS-related), emergency department (ED) visits (all-cause, MS-related, and non-MS-related), and relapse-related hospitalizations and outpatient visits were independently evaluated during the 365-day follow-up. Patients were observed until the occurrence of an event (depending on the model), deviation from the treatment group, disenrollment, death, end of follow-up, or data unavailability. Stabilized inverse probability of treatment weighting (sIPTW) was employed to balance the 2 groups. The associations between DMT discontinuation and each utilization outcome were estimated using Cox proportional hazard regression models with sIPTW.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 149,721 midlife patients with MS, 22.8% discontinued DMTs and 77.2% continued DMTs. Patients who discontinued DMTs had a higher cumulative incidence for all utilization outcomes during the 365-day follow-up than those who continued DMTs. Cox regression showed that DMT discontinuation was associated with a 10.3% and 24.9% higher rate of all-cause and non-MS-related inpatient hospitalizations, respectively, with no significant association found for MS-related hospitalizations. Patients discontinuing DMTs exhibited higher utilization rates for ED visits, with an increase of 21.3% for all-cause, 23.0% for MS-related, and 20.9% for non-MS-related visits compared with those who continued DMTs. We also observed a 15.9% and 52.1% higher rate of relapse-related hospitalizations and outpatient visits associated with DMT discontinuation, respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study revealed that DMT discontinuation was associated with higher health care services utilization among midlife patients with MS, especially relapse-related outpatient visits. DMT discontinuation during midlife may be premature, and DMTs may still","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"30 11","pages":"1248-1260"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social determinants of health and newer glucose-lowering drugs adoption among US Medicare beneficiaries with type 2 diabetes.","authors":"Wei-Han Chen, Yujia Li, Aokun Chen, John M Allen, Yi Guo, Lori Bilello, Steven M Smith, Lanting Yang, Amie J Goodin, Jiang Bian, Jingchuan Guo","doi":"10.18553/jmcp.2024.30.11.1298","DOIUrl":"10.18553/jmcp.2024.30.11.1298","url":null,"abstract":"<p><strong>Background: </strong>Two classes of newer glucose-lowering drugs (GLDs), sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, improve cardiovascular and renal outcomes among patients with type 2 diabetes (T2D). However, racial and ethnic minority groups carry higher cardiovascular risks but have lower access to newer GLDs. Contextual-level social determinants of health (SDOH) may be the underlying factor associated with newer GLD adoption.</p><p><strong>Objective: </strong>To identify the association between contextual-level SDOH and real-world adoption of newer GLDs among Medicare beneficiaries and to examine the nonstationarity in the associations.</p><p><strong>Methods: </strong>Data were from 15% random samples of January 2017 to December 2018 nationwide Medicare beneficiaries. We identified patients with T2D who did not use newer GLDs in the year before the index date-January 1, 2018-and followed the cohort for 1 year to record their status of initiating a newer GLD. We used a geographically weighted multivariable Poisson regression model to determine to what extent the SDOH-newer GLD initiation association (β coefficient) varied geographically.</p><p><strong>Results: </strong>We identified 795,469 eligible Medicare beneficiaries with T2D during the study period from our dataset. Of the study cohort, mean age was 73.1 (SD = 10.5) years, 424,312 (53.3%) were female, 562,994 (70.8%) were non-Hispanic White, 96,891 (12.2%) were non-Hispanic Black, 84,744 (10.6%) were Hispanic, and 29,645 (3.7%) were Asian/Pacific Islander. Newer GLD initiation was negatively associated with the percentage of the population reporting non-Hispanic Black race, Hispanic ethnicity, and unemployment, as revealed by nonspatial regression analyses. The county-level median household income was also associated with higher newer GLD initiation. The spatial analysis presented distinct distributions of local parameter estimates for each contextual-level SDOH.</p><p><strong>Conclusions: </strong>We identified key contextual-level SDOH associated with real-world adoption of newer GLDs and explored their geographic variation through spatially explicit, data-driven analytical approaches. Identifying areas of strong association between SDOH and newer GLD initiation is crucial for policymakers to allocate resources and develop interventions that address structural inequities.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"30 11","pages":"1298-1307"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A descriptive survey of patient experiences and access to specialty medicines with alternative funding programs.","authors":"William B Wong, Irina Yermilov, Hannah Dalglish, Lori Bienvenu, Jonathan James, Sarah N Gibbs","doi":"10.18553/jmcp.2024.30.11.1308","DOIUrl":"10.18553/jmcp.2024.30.11.1308","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Alternative funding programs (AFPs) seek to reduce health plan sponsor costs, for example by excluding specialty drugs from a beneficiary's plan coverage and requiring patients to obtain medications through alternative sources (typically, the manufacturer's patient assistance programs) via an AFP vendor as a third-party.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To describe patients' experiences and specialty medication access with AFPs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A survey method consisting of 26 optional single-choice and multiple-choice questions with branching logic divided across 5 sections (related to patient challenges with AFPs) was administered to patients recruited from an experienced AFP online patient panel and a patient advocacy group. The survey assessed patients' awareness of AFPs from their employers, experience with the patient assistance program application process via the AFP vendor, timeliness of medication access (if granted), and/or the health impact of delay in access. All descriptive and exploratory subgroup analyses were conducted by disease area and reported income levels; statistical analyses were carried out for the exploratory analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The final sample included 227 patients. Most patients (61% [136/223]) first heard of the AFP as part of their health benefit when trying to obtain their medication. Of 198 patients, 88% reported being stressed because of the medication coverage denial and the uncertainty of obtaining their medication. More than half of patients (54% [115/213]) reported being uncomfortable with the benefits manager from the AFP vendor. On average, patients reported waiting to receive their medication for 68.2 days (approximately 2 months); 24% (51/215) reported the wait for the medication worsened their condition and 64% (138/215) reported the wait led to stress and/or anxiety. Patients who indicated the wait time negatively affected them had considered a job change or left their job at a 3-5-fold higher rate than those who reported no impact from wait time. A significantly higher proportion of patients with hemophilia and other bleeding disorders reported receiving their prescribed medication less often than patients with other conditions (63% [19/30] vs 81% [52/64]; &lt;i&gt;P&lt;/i&gt; = 0.022), whereas more patients with lower incomes (&lt;$50,000 vs &gt;$50,000) reported not receiving any medication (12% [7/57] vs 5% [7/129]; &lt;i&gt;P&lt;/i&gt; = 0.657), although these differences were not significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Most patients who obtain their specialty medicines via AFPs reported being uncomfortable with the process and experiencing treatment delays, which may have been linked to disease progression, worsened mental well-being, and consideration of a job change. Employers should be aware of the potential downstream impacts on employee health, retention, and the employee-employer relationship when considering implementing an AFP into their he","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"30 11","pages":"1308-1316"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unlocking the potential of digital therapeutics: The need for consistent and granular inclusion in drug compendia for managed care.","authors":"Ann Johnson, Rick Bartels, Joe Honcz, Jennifer S Graff, Jann B Skelton","doi":"10.18553/jmcp.2024.30.11.1318","DOIUrl":"10.18553/jmcp.2024.30.11.1318","url":null,"abstract":"<p><p>The field of digital therapeutics (DTx), software programs that prevent, manage, and treat medical conditions, continues to grow. DTx offers new treatment options and has the potential to close gaps in care caused by unmet patient needs, provider shortages, or socioeconomic or geographical disparities. However, the field of DTx has not seen steady adoption owing to barriers, particularly related to coverage, payer acceptance of the category, provider use, and integration within existing health care delivery tools. One challenge for payers to effectively evaluate and cover DTx products is ensuring that consistent data elements are listed for these products in traditional drug compendia databases. Managed care organizations will need similar information about DTx product features as are available for traditional medications to inform coverage and reimbursement decisions. The Academy of Managed Care Pharmacy DTx Advisory Group developed and distributed a request for information to the 5 top drug compendia companies to assess how compendia products incorporate DTx and prescription DTx. This article summarizes how DTx are listed within different compendia products and offers insights on future data needs to adequately inform payers. As the DTx sector grows and consumer demand rises, compendia listing services will need to evolve to accommodate these new therapies and treatment modalities and facilitate patient access and efficient claims processing. Recommendations for how compendia companies can support managed care in these efforts are outlined.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"30 11","pages":"1318-1326"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential benefits of incorporating social determinants of health screening on comprehensive medication management effectiveness.","authors":"Joel F Farley, Swetha Pradeep","doi":"10.18553/jmcp.2024.30.11.1217","DOIUrl":"10.18553/jmcp.2024.30.11.1217","url":null,"abstract":"<p><strong>Background: </strong>Increasingly, pharmacists are asked to incorporate social determinants of health (SDoH) identification and referral into clinical practice. However, to date, no studies have evaluated clinical changes from embedding SDoH screening into the delivery of comprehensive medication management (CMM) in patients with chronic conditions.</p><p><strong>Objective: </strong>To examine the clinical effectiveness of implementing a clinical pharmacist-led SDoH screening and referral process as part of CMM encounters across a network of 7 Federally Qualified Health Centers (FQHCs).</p><p><strong>Methods: </strong>We used a retrospective cohort design to evaluate the effectiveness of integrating SDoH screening into CMM across a network of 7 FQHCs. A difference-in-difference approach was used to compare the effectiveness of CMM between patients with and without SDoH needs on the probability of achieving clinical control for blood pressure (<140 systolic/90 diastolic mm Hg) and diabetes (<9% hemoglobin A1c).</p><p><strong>Results: </strong>Among 807 patients receiving CMM in 2023, 595 (74%) were screened for SDoH. 55.1% of patients screened had 1 or more SDoH, most commonly facing barriers related to insurance (22.0%), language (11.3%), transportation (9.1%), health behaviors (7.1%), income/employment (5.9%), and food insecurity (5.6%). Comparing patients with SDoH needs with those without, the proportion of patients controlled at baseline was 66.3% vs 72.3% for hypertension and 39.0% vs 75.4% for diabetes, respectively. Following a CMM encounter, the proportion of patients who achieved blood pressure control increased 7.6% more (<i>P</i> = 0.225) among patients with SDoH needs than in those without SDoH, whereas diabetes control rates increased 13.3% more (<i>P</i> = 0.143).</p><p><strong>Conclusions: </strong>Although not statistically significant, the results of this pilot evaluation suggest the potential for meaningful clinical improvements from screening and referral of SDoH needs as a part of CMM encounters. These results should be corroborated using a larger, more robust study design.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"30 11","pages":"1217-1224"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing health care resource use, outcomes, and costs among Medicaid beneficiaries receiving factor IX prophylaxis for hemophilia B.","authors":"Nathan Pauly, Anita Burrell, Douglass Drelich, Xiang Zhang, Kris Thiruvillakkat, Jessica Nysenbaum, Anthony Fiori, Songkai Yan","doi":"10.18553/jmcp.2024.23328","DOIUrl":"10.18553/jmcp.2024.23328","url":null,"abstract":"<p><strong>Background: </strong>Hemophilia B is characterized by a deficiency of clotting factor IX (FIX), leading to excessive bleeding. Hemophilia B is commonly treated using replacement FIX therapy, which may be administered prophylactically or on-demand following a bleeding episode. Previous research has found high health care resource use (HCRU) and costs among Medicare and commercially insured people with hemophilia B (PwHB), with FIX therapy being a primary driver of health care costs.</p><p><strong>Objective: </strong>To assess HCRU, outcomes, and costs among US Medicaid beneficiaries receiving FIX prophylaxis for hemophilia B.</p><p><strong>Methods: </strong>This study employed a retrospective comparative cohort design to assess HCRU, outcomes, and costs among adult male Medicaid beneficiaries receiving FIX prophylaxis for hemophilia B, relative to a matched comparator population of beneficiaries without bleeding disorders. Nationwide Medicaid claims and enrollment data from 2015 to 2020 were used for this analysis. Adult male PwHB who received FIX prophylaxis, defined as not having identified gaps in FIX therapy exceeding 60-days during a 1-year measurement period, and were continuously enrolled in Medicaid for at least 2 years, were matched 1:4 to comparator beneficiaries without bleeding disorders based on baseline demographic and clinical characteristics. Key measures of HCRU and outcomes included inpatient hospital admissions, outpatient hematologist visits, and bleeding events. Measures of health care costs were assessed among a subset of beneficiaries enrolled in fee-for-service Medicaid.</p><p><strong>Results: </strong>PwHB receiving FIX prophylaxis were significantly more likely to have multiple inpatient hospital admissions and had a longer cumulative length of stay per person relative to comparator beneficiaries (30.2 vs 14.8 days, respectively; <i>P</i> = 0.0473). PwHB receiving FIX prophylaxis also had significantly higher rates of bleeding events relative to comparator beneficiaries (0.54 vs 0.02 per person, respectively; <i>P</i> < 0.0001) and outpatient hematologist visits (1.58 vs 0.20 per person, respectively; <i>P</i> < 0.0001). Annual costs among PwHB receiving FIX prophylaxis were significantly higher than costs among comparator beneficiaries ($928,370 vs $34,553 per person, respectively; <i>P</i> < 0.0001) and were overwhelmingly driven by costs associated with FIX therapy.</p><p><strong>Conclusions: </strong>This analysis found higher rates of HCRU and costs among Medicaid beneficiaries receiving FIX prophylaxis for hemophilia B relative to a matched comparator population of beneficiaries without bleeding disorders. Future research should examine hemophilia B costs and outcomes within the context of new treatments with innovative mechanisms of action, such as gene therapies, RNA interference therapies, and antitissue factor pathway inhibitor therapies.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"1095-1105"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11424919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141457409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary perspectives in <i>Demodex</i> blepharitis: A new view of treatment from clinical, payer, and patient perspectives.","authors":"Michael R Page","doi":"10.18553/jmcp.2024.30.10-a.s1","DOIUrl":"10.18553/jmcp.2024.30.10-a.s1","url":null,"abstract":"<p><p><i>Demodex</i> infestation is the cause of more than two-thirds of all cases of blepharitis in the United States. Although symptoms may include crustiness, redness, or itching of the eyelids, diagnosis can be accomplished through a simple examination of the eyelashes. The presence of a waste product of the <i>Demodex</i> mite, known as collarettes, on the base of the eyelashes is a pathognomonic sign of <i>Demodex</i> blepharitis. <i>Demodex</i> infestation that results in blepharitis may cause blockage and ultimately atrophy of the meibomian glands, worsening dry eye disease. Until recently, management of <i>Demodex</i> blepharitis has been limited by a lack of approved therapy options. Lotilaner ophthalmic solution 0.25%, the first approved therapy for treatment of <i>Demodex</i> blepharitis, has not only been shown to eradicate <i>Demodex</i> mites in one-half to two-thirds of patients following short-term treatment but also demonstrated continued benefits through 1 year of follow-up. In addition to managing <i>Demodex</i> blepharitis, treatment with lotilaner ophthalmic solution 0.25% may aid in the management of dry eye disease and other forms of ocular surface disease caused by complications of <i>Demodex</i> infestation. As a result, it is possible that successful management of <i>Demodex</i> blepharitis may reduce chronic use of health care resources dedicated to managing other chronic ocular conditions. As eye care professionals recognize <i>Demodex</i> infestation as a key mediator of ocular surface disease, increasing diagnostic awareness and addressing this underlying cause of <i>Demodex</i> blepharitis may reduce the need for specialist follow-up care, decrease the need for chronic therapy, and improve patient outcomes. Through routine screening for <i>Demodex</i> infestation and <i>Demodex</i> blepharitis, eye care professionals can now address an underlying factor in ocular surface disease to improve use of health care resources in the community.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"30 10-a Suppl","pages":"S1-S8"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11368203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing gaps to strengthen patient-centricity in formulary decision-making: An example applied to Colorado's prescription drug affordability board implementation.","authors":"Joe Vandigo, Hillary A Edwards, Bridget Seritt, Kavita V Nair","doi":"10.18553/jmcp.2024.30.10.1189","DOIUrl":"10.18553/jmcp.2024.30.10.1189","url":null,"abstract":"","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"30 10","pages":"1189-1190"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11424915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}