Driving Market Share in an Integrated Health System without Therapeutic Interchange

Abstract

OBJECTIVE: Shift selective serotonin reuptake inhibitor (SSRI) market share in a large integrated health system to a more cost-effective alternative without the need for therapeutic interchange. SETTING: University of California Davis Medical Group (UCDMG). PRACTICE INNOVATION: Integrate the managed care team into the routine operation of the medical group clinics. Influence prescribing patterns by a program of continuous physician education, giving the messages that (1) citalopram was the most costeffective SSRI; (2) fluoxetine is the least cost-effective, especially at doses above 20 mg; and (3) that citalopram should be considered as initial therapy for depression and for patients not achieving optimal therapy on their current SSRI. OUTCOMES MEASURES: Change in market share for SSRIs: prescriptions for citalopram and fluoxetine were monitored for a year after the physician education program began. RESULTS: Market share for citalopram increased dramatically. Starting below the reported national usage, the market share for citalopram at UCDMG increased to above the national average and the market share for fluoxetine decreased. Yearly estimated cost savings totaled $126,000 8% of SSRI ingredient cost. CONCLUSION: It is possible to shift market share even in a large health system without requiring therapeutic interchange.