Drug Expenses Research Articles

CLINICAL AND ECONOMIC ANALYSIS OF GENETICALLY ENGINEERED BIOLOGICS CONSUMPTION BY PATIENTS WITH COVID-19

The aim of the article is a comparative clinical and economic assessment of genetically engineered monoclonal antibodies against interleukins in infectious diseases facilities in Volgograd region, reassigned to treat COVID-19 patients.Materials and methods. ABC analysis of the drug consumption in infectious disease facilities in Volgograd region in 2020 and 2021, cost-minimization analysis, and volume of consumption (standard dose per 1000 patients) for genetically engineered monoclonal antibodies against interleukins, were performed on the basis of pharmacies dispensing drug reports on infectious diseases facilities, Russian State Register of maximum selling prices, and Russian guidelines for COVID-19 treatment.Results. Only a small proportion of COVID-19 patients (43.6 standard doses per 1000 patients in 2020 and 137.8 per 1000 patients in 2021) received genetically engineered biologics in infectious disease facilities in Volgograd Region. Ne-vertheless, in the studied facilities, medical drug expenses on them exceeded from 20% in 2020 to 40% of the total inventory value in 2021. In mild COVID-19 patients with a high comorbidity index, netaquimab was the least expensive drug therapy and levilimab was the most expensive one. For moderate COVID-19, a standart recommended dose of sarilumab was the least expensive among the drugs used in the studied facilities, and anakinra was the least expensive drug among all the recommended GEBs. In severe and extremely severe COVID-19 courses, tocilizumab and sarilumab were less the least expensive among the GEBs used in the infectious disease facilities, and anakinra was the least expensive among all the recommended GEBs.Conclusion. Accepting a possible equal effectiveness based on the currently available data, sarilumab is the least expensive for moderate COVID-19 and tocilizumab is the least expensive for severe and extremely severe COVID-19.

Healthcare Utilization with Drug Acquisition and Expenses at the National Health Insurance Fund in Sudan.

Background: Understanding the pattern of care use can provide valuable information for reform interventions. This study investigates the pattern of healthcare utilization and its association with drug acquisition patterns and expenses in the National Health Insurance Fund (NHIF) of Al Jazira State in Sudan. Methods: A cross-sectional survey was conducted at NHIF primary healthcare centers of Al Jazirah state in Sudan. Results: A total of 768 beneficiaries were interviewed, of which 63.2% reported using out-of-network physician care, while 36.8% receive care from the NHIF physician network only. More than half (60.8%) of NHIF-interviewed clients reported a heavy burden of medication costs. The pattern of physician utilization was significantly associated with the number and source of regular drugs, the burden of out-of-pocket payment, and monthly out-of-pocket expenditures on medications, (p < 0.001). The regression analysis revealed that gender, marital status, number of chronic diseases, and number of regular drugs were the significant predictors of the pattern of physician care utilization; these factors explained nearly 36% of the variance in respondents’ pattern of physician care utilization. Conclusions: An impressive proportion of out-of-network care was found in Al Jazirah State in Sudan. The NHIF stakeholders should consider medication subsidy as a potential strategy for decreasing patient leakage to out-of-network services.

In-patient Expenditure Between 2012 and 2020 Concerning Patients With Liver Cirrhosis in Chongqing: A Hospital-Based Multicenter Retrospective Study.

BackgroundLiver cirrhosis is a major global health and economic challenge, placing a heavy economic burden on patients, families, and society. This study aimed to investigate medical expenditure trends in patients with liver cirrhosis and assess the drivers for such medical expenditure among patients with liver cirrhosis.MethodsMedical expenditure data concerning patients with liver cirrhosis was collected in six tertiary hospitals in Chongqing, China, from 2012 to 2020. Trends in medical expenses over time and trends according to subgroups were described, and medical expenditure compositions were analyzed. A multiple linear regression model was constructed to evaluate the factors influencing medical expenditure. All expenditure data were reported in Chinese Yuan (CNY), based on the 2020 value, and adjusted using the year-specific health care consumer price index for Chongqing.ResultsMedical expenditure for 7,095 patients was assessed. The average medical expenditure per patient was 16,177 CNY. An upward trend in medical expenditure was observed in almost all patient subgroups. Drug expenses were the largest contributor to medical expenditure in 2020. A multiple linear regression model showed that insurance type, sex, age at diagnosis, marital status, length of stay, smoking status, drinking status, number of complications, autoimmune liver disease, and the age-adjusted Charlson comorbidity index score were significantly related to medical expenditure.ConclusionConservative estimates suggest that the medical expenditure of patients with liver cirrhosis increased significantly from 2012 to 2020. Therefore, it is necessary to formulate targeted measures to reduce the personal burden on patients with liver cirrhosis.

Evaluating the effectiveness of drug and therapeutics committees (DTCs) in controlling irrational drug use: Aretrospective analysis.

This study aimed to explore methods to optimize the function of Drug and Therapeutics Committees (DTCs) in controlling irrational drug use. Clinical pharmacologists contribute their specific knowledge and skills to DTCs and help guide rational therapeutics. The DTC is the highest organization of hospital pharmacy management. From January 2016 to August 2021, the DTC promoted the optimization of clinical drug treatment schemes and reduced unreasonable drug use by improving the organizational framework, clarifying the division of functions, regularly monitoring drug use, organizing expert comments, scientific decision-making and functional intervention. During this time, we statistically analysed typical management cases, irrational drug use and drug cost to evaluate the effectiveness of the DTC's management. The DTC's intervention led to a significant reduction in prescribing errors (65.98%, p<0.05); the intervention acceptance rate increased by 16.37%; and the rate of problem resolution increased by 45.84% (p<0.05). The level of drug treatment was improved, and the proportion of patients' drug expenses was reduced. The DTC carried out a series of continuous improvement work that played a significant normative role in clinical drug use. Giving more power to the DTCs can significantly improve the level of drug treatment and reduce unreasonable drug use, which reduces unnecessary drug expenses.

Evaluating the direct medical cost, drug utilization and expenditure for managing Parkinson's disease: a costing study at a medical center in China.

BackgroundWith long-term pharmacotherapy, Parkinson’s disease (PD) is expectedly to incur a significant healthcare burden. However, drug utilization and costing study is limited, so is the cost composition and its impact on resource allocation. This study took a healthcare provider’s perspective to quantify medical and drug expenses and the utilization of drugs for managing PD and its complications.MethodsMedical resources use and associated cost of outpatient visits and inpatient admission episodes for PD patients were extracted from electronic medical records at a tertiary hospital in China from 1 January 2016 to 15 August 2018. Total and average direct medical (costs of outpatient visits and inpatient admission episodes) and drug costs were calculated during the study period and each calendar year. Drug cost was quantified by defined daily dose cost (DDDc) and levodopa equivalent dose cost (LEDc) per outpatient visit or inpatient admission episode for PD in Chinese yuan (¥), stratified by medication categories, and presented in descriptive statistics.ResultsOverall, 18,158 outpatient visits and 366 inpatient admissions were incurred by 2,640 outpatients and 330 inpatients, with a median age of 71.0 and 73.5 years, respectively. Drug cost accounted for 97.82% and 23.33% of outpatient and inpatient medical expenditure. The average cost of drugs for managing PD accounted for 60.48% (¥952.50) and 2.70% (¥564.90) of cost per outpatient visit and inpatient episode, while drugs for managing PD complications was 11.38% and 0.70%, respectively. The highest DDDc and LEDc of drugs for managing PD per outpatient visit or inpatient episode were incurred by pramipexole (¥56.90–72.70 and ¥227.48–290.67) and entacapone (¥37.70–45.70 and ¥228.64–276.77). The DDDc and LEDc of pramipexole is more than 10 times that of levodopa/benserazide (DDDc: ¥4.90–5.70; LEDc: ¥10.14–11.98) and carbidopa/levodopa (DDDc: ¥4.00–5.00; LEDc: ¥11.02–13.95).ConclusionsThe outpatient direct medical cost for patients with PD was predominantly attributed to drug cost for managing PD, but drug cost weighed less of the inpatient cost. After adjusting the dose and number of patients, drugs with indirect dopamine effects had an excessively higher cost than dopamine precursors. Their long-term cost-effectiveness in real-world settings warrants further studies.

Abstract P1-18-31: Accessibility of CDK4/6 inhibitors for breast cancer patients in the Netherlands

Abstract Background: Before new cancer drugs are available to patients, they must obtain regulatory approval by international authorities. In many countries new drugs are also subject to health technology assessment procedures to decide on the reimbursement. When these procedures are completed, new drugs need to be adopted into clinical practice. All these processes take time and may delay or hamper patient access. In this study we investigated the access to CDK4/6 inhibitors for HR+Her2- metastatic breast cancer patients in daily practice in the Netherlands and explored whether certain policy procedures may have influenced accessibility. Method: For this study we used a mixed method approach. For our qualitative analysis, we used publicly available documents describing drug approval and reimbursement decisions and clinical practice recommendations. Information from these documents were used to provide a timeline of procedures involved and decisions made to make CDK4/6 inhibitors available to patients in the Netherlands. For our quantitative analysis we used monthly prescription data to calculate the number of patients treated with CDK4/6 inhibitors each month, to describe the trends over time and to calculate annual drug expenses. The monthly number of patients treated were compared to an estimated number of patients eligible for the drugs as per European Medicine Association (EMA) label. The trends were compared to the decision timeline in order to identify as to whether certain procedures and/or decisions may have been associated with accessibility to CDK4/6 inhibitors in the Netherlands. Results: In June 2017, the first approved CDK4/6 inhibitor - palbociclib - was prescribed for breast cancer for the first time in the Netherlands. This was approximately 7 months after the EMA gave a positive opinion for marketing authorization. This delay was caused by pricing and reimbursement procedures which involved a thorough evaluation of the costs and effects of the drug and negotiations with the manufacturer. After prescribing palbociclib for the first time, the utilization of CDK4/6 inhibitors in clinical practice increased rapidly with a gradual increase from zero to approximately 1400 patients over a period of 30 months. The majority of patients were treated with palbociclib even after the approval of other drugs of this class (i.e. in December 2019: palbociclib 94% ribociclib 6% and abemaciclib &amp;lt;1%). In addition, approximately 63% of patients were treated with a CKD4/6 inhibitor combined with fulvestrant. The pattern of utilization over time appeared to correspond quite well to the estimated number of patients eligible but these estimates were surrounded by a substantial amount of uncertainty. The total expenses of the CDK4/6 inhibitors from 2017 to 2019 were approximately 3.5 times smaller than the estimates made by the health authorities in the Netherlands prior to the decision to reimburse the drugs. Conclusion: Pricing and reimbursement decisions caused a significant delay in access to the newest drugs for HR+/HER2- metastatic breast cancer. Nevertheless, after palbociclib - the first approved CDK4/6 inhibitor - received a positive reimbursement decision, the prescription in daily practice increased rapidly, a pattern not seen in the other drugs of this class. Though the number of patients treated appeared to be in line with the projected number of patients eligible for these drugs, detailed information regarding metastatic breast cancer patients, their treatments and the decision making process in daily practice is needed to fully understand access to the newest drugs. Citation Format: Marianne Luyendijk, Hedwig Blommestein, Agnes Jager, Sabine Siesling, Carin Uyl-de Groot. Accessibility of CDK4/6 inhibitors for breast cancer patients in the Netherlands [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-18-31.

Construction of Scientific Management Mode of "Adjuvant Drugs" Based on Evidence-Based Medicine

This study aimed to standardize the clinical application of adjuvant drugs and control the unreason-able increase in drug costs. Management measures were formulated for adjuvant drug utilization by promoting the rational use of adjuvant drugs. The efficacy and economics of the same types of drugs were compared to provide a scientific reference for clinical drug selection. In 2018, the total cost of the use of adjuvant drugs decreased by 7.4117 million renminbi compared with that in 2015. In the first half of 2019, the proportion of revenue from adjuvant drugs decreased by 10.77 % from that in the same period in 2015. From 2015 to 2018, the per capita drug cost of adjuvant drugs gradually decreased and in 2018, this resulted in savings of 568.41 renminbi. Through administrative intervention, prescription review, information management and pharmaco-economic evaluation, a scientific management system of adjuvant drugs was established to standardize the use of adjuvant drugs and to reduce their cost. The scientific management of adjuvant drugs can avoid unnecessary drug expenses for patients and provide effective reference values for the rational use of adjuvant drugs in hospitals.

Mapping naso-ocular symptom scores to EQ-5D-5L utility values in Japanese cedar pollinosis

BackgroundThe total naso-ocular symptom score (TSS) is widely used as an endpoint to evaluate the severity of seasonal allergic rhinitis. However, it is not a generic preference-based measure. We sought to develop an algorithm for mapping between the TSS and health utility in Japanese cedar pollinosis (JCP). We also performed a cost-utility analysis of sublingual immunotherapy (SLIT) for JCP by using this algorithm. MethodsPatients with JCP filled out the TSS questionnaire and EQ-5D-5L simultaneously during the pollen season in 2019 and in 2020. We estimated a direct utility mapping model by regressing responses to individual TSS questions directly onto utility. The incremental cost-effectiveness ratio (ICER) of active SLIT to a placebo was determined by examining the drug expense and the estimated quality-adjusted life year (QALY) using a dataset from a double-blind placebo-controlled clinical trial. ResultsA total of 238 records were included for analysis. The estimated utility decreased with increasing severity of rhinitis. Patients with comorbid asthma showed lower utility. A negative and significant correlation was seen between the TSS and utility in both 2019 and 2020. The estimated equations were: Y(utility) = −0.0161∗X(TSS) + 1.005 in non-asthmatic JCP patients. The ICER of active SLIT to the placebo was estimated to be 4,049,720 and 6,011,218 JPY/QALY in the first and second year, respectively. ConclusionsIt is possible to reasonably predict utility from the total naso-ocular symptom score by using regression models. In the estimated algorithm, pre-seasonal SLIT for JCP is cost-effective.

Financial Impact of an Automated Oncology Dose-Rounding Initiative: One-Year Analysis.

Infusion drugs are regarded as one of the high-cost health care expenditures. One approach to decrease drug expenditures is by dose-rounding biologics and cytotoxic agents. The Hematology/Oncology Pharmacy Association recommends that biologic and cytotoxic agents are rounded to the nearest vial size if they are within 10% of the ordered dose. The purpose of this initiative is to determine the impact of an automated dose-rounding algorithm on drug expenses. The dose-rounding algorithm was developed and integrated into the computerized physician order entry system for automated dose rounding to minimize impact on current workflow and to reduce medication errors. Twenty-four medications were preselected for dose rounding and included in the analysis. Ordered doses were automatically rounded to the nearest vial size if the dose was within 10% of the original dose. Prescribers then either reviewed and signed the rounded dose or manually entered the nonrounded dose. Cost savings were calculated as drug expense savings from doses rounded down. From July 2018 to June 2019, 10,206 doses of the selected medications were administered. Dose rounding occurred in 5,069 doses (49.7%). All 24 medications within the initiative were administered within the time of analysis. Of the rounded doses administered, 2,516 (49.6%) were rounded down to a commercially available vial size. Using wholesale acquisition cost pricing, the drug expense savings was approximately $3.6 million US dollars (USD). The medications with the highest savings were trastuzumab and ipilimumab, with annual savings of $756,780 USD and $494,517 USD, respectively. The automated dose-rounding algorithm at Michigan Medicine reduced drug expenditures substantially, and its integration within the computerized physician order entry system had minimal impact on current workflow.

Clinical Outcome and Drug Expenses of Intravitreal Therapy for Diabetic Macular Edema: A Retrospective Study in Sardinia, Italy.

Background: Diabetic macular edema (DME) is a leading cause of visual loss in working-age adults. The purpose of this retrospective study was to perform an epidemiological analysis on DME patients treated with intravitreal drugs in a tertiary hospital. The clinical outcome, adverse drug reactions (ADRs), and intravitreal drug expenses were assessed. Methods: All DME patients treated with Ranibizumab, Aflibercept, Dexamethasone implant, and Fluocinolone Acetonide implant at the Sassari University Hospital, Italy, between January 2017 and June 2020 were included. Central macular thickness (CMT) and best corrected visual acuity (BCVA) were measured. ADRs and drug expenses were analyzed. Results: Two-hundred thirty-one DME patients (mean age: 65 years) received intravitreal agents. Mean CMT and BCVA were 380 μm and 0.5 LogMAR at baseline, 298 μm and 0.44 logMAR after one year (p = 0.04), and 295 μm and 0.4 logMAR at the end of the follow-up period. A total of 1501 intravitreal injections were given; no major ADRs were reported. Treatment cost was €915,000 (€261,429/year). Twenty non-responders to Ranibizumab or Aflibercept were switched to a Dexamethasone implant. In these patients, mean CMT and BCVA were 468 µm and 0.5 LogMar at the time of switching and 362 µm and 0.3 LogMar at the end of the follow-up (p = 0.00014 and p = 0.08, respectively). Conclusion: Results confirm that Ranibizumab, Aflibercept, and Dexamethasone implant are effective and safe in DME treatment. A switch to Dexamethasone implant for patients receiving Aflibercept or Ranibizumab with minimal/no clinical benefit should be considered.

Towards Fixed Dosing of Tocilizumab in ICU-Admitted COVID-19 Patients: Results of an Observational Population Pharmacokinetic and Descriptive Pharmacodynamic Study.

Background and ObjectiveIn the randomized controlled trial REMAP-CAP, it was shown that next to dexamethasone, the interleukin (IL)-6 receptor antagonist tocilizumab improves outcome, including survival in intensive care unit (ICU)-admitted coronavirus disease 2019 (COVID)-19 patients. Therefore tocilizumab has been added to many COVID-19 treatment guidelines. Because obesity is a risk factor for the development of severe COVID-19, concerns have been raised about overtreatment, as well as undertreatment, through weight-based dosing of tocilizumab. The currently applied dose of 8 mg/kg is based on the use of this drug for other indications, however it has not formally been investigated for COVID-19. In this study, the pharmacokinetics and pharmacodynamics of tocilizumab were investigated in ICU-admitted COVID-19 patients.MethodsThis was an open-label, single-centre, observational population pharmacokinetic and descriptive pharmacodynamic evaluation study. Enrolled patients, with polymerase chain reaction-confirmed COVID-19 were admitted to the ICU for mechanical ventilation or high flow nasal canula oxygen support. All patients were 18 years of age or older and received intravenous tocilizumab 8 mg/kg (maximum 800 mg) within 24 h after admission to the ICU and received dexamethasone 6 mg daily as concomitant therapy. For evaluation of the pharmacokinetics and pharmacodynamics of tocilizumab, all time points from day 0 to 20 days after dose administration were eligible for collection. A nonlinear mixed-effects model was developed to characterize the population pharmacokinetic parameters of tocilizumab in ICU-admitted COVID-19 patients. Covariate analysis was performed to identify potential covariates for dose individualization. For the development of alternative dosing schedules, Monte Carlo simulations using the final model were performed.ResultsOverall, 29 patients were enrolled between 15 December 2020 and 15 March 2021. A total of 139 tocilizumab plasma samples were obtained covering the pharmacokinetic curve of day 0 to day 20 after tocilizumab initiation. A population pharmacokinetic model with parallel linear and nonlinear clearance (CL) was developed and validated. Average CL was estimated to be 0.725 L/day, average volume of distribution (Vd) was 4.34 L, maximum elimination rate (Vmax) was 4.19 μg/day, and concentration at which the elimination pathway is half saturated (Km) was 0.22 μg/mL. Interindividual variability was identified for CL (18.9%) and Vd (21%). Average area under the concentration versus time curve from time zero to infinity of the first dose (AUCinf 1st DOSE) was 938 [±190] μg/mL*days. All patients had tocilizumab exposure above 1 μg/mL for at least 15 days. Bodyweight-based dosing increases variability in exposure compared with fixed dosing.ConclusionsThis study provides evidence to support a fixed dose of tocilizumab 600 mg in COVID-19 patients. Fixed dosing is a safe, logistically attractive, and drug expenses saving alternative compared with the current 8 mg/kg recommendation.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40262-021-01074-2.

P-117: Multiple Myeloma treatment patterns and outcomes in the public and private healthcare systems in Brazil: one country, two worlds

<h3>Background</h3> Over the past two decades, the approval of several novel drugs has broadened therapeutic options for multiple myeloma (MM) patients, but has also raised concerns about increasing drug expenses and healthcare costs in general. Access to these treatments in public and private settings in Brazil differs significantly and it is unknown if shortcomings in treatment availability affect patient outcomes. The aim was to understand the patient characteristics, treatment patterns and MM patient outcomes in private and public settings in Brazil. <h3>Methods</h3> MMyBrave is an observational, retrospective study with no control group. Eligible patients were diagnosed with active MM between January 1, 2008 and December 31, 2016 (cut-off date), at 17 public and private medical centers in Brazil. The MM diagnosis was performed according to investigator assessment. Data collection started on June 2018, after ethical approval, and progressed until August 2019. Demographic and clinical characteristics were collected. Patients were stratified according to eligibility to transplant (intention-to-treat analysis) and treatment setting (public or private health systems). The overall survival (OS) was analyzed using the Kaplan-Meier (KM) curve and Cox's proportional-hazards model. <h3>Results</h3> A total of 943 patients were included. Private and public centers accounted for 44.9 and 55.1% of patients, respectively. The age (≥65 years) and female percentage at private and public centers were 64.2 and 63.4%; and 43.6 and 48.6, respectively. The International Staging System stages I, II, III and stage unknown were: 26.7, 22.6, 25.7 and 25.0 at private centers and 13.3, 20.2, 27.4, 39.1 at public centers. A total of 47.9% (50.2% private and 46.1% public) were eligible for autologous stem cell transplantation (ASCT). Proteasome inhibitor (PI) regimens (mainly bortezomib-based) were used by 52.8% at private centers (57.3% in ASCT eligible; 48.3% in ASCT ineligible). MM patients in the private health system had a higher overall survival (OS) than those in the public setting (75.9 x 63.3 months, p=0,007). <h3>Conclusion</h3> Real-world MM patient outcomes at private and public institutions in Brazil were quite different, with significantly higher OS in those followed in the Brazilian private healthcare system. Disease staging and treatment response were found as independent OS predictors, regardless reimbursement setting and ASCT eligibility. These preliminary results raise the hypothesis that the superior OS among patients in the private healthcare system may be due to a wider availability of therapies.

The effects of medical insurance and patients’ preference on manufacturer encroachment in a pharmaceutical supply chain

With the development of e-commerce, manufacturers have opportunities to sell products to consumers through direct channels in addition to independent retailers. Although manufacturers’ encroachment upon the retailing market of traditional goods has been extensively studied, there is a lack of research on manufacturers’ encroachment in a pharmaceutical supply chain. This paper analyzes a pharmaceutical manufacturer encroachment strategy by taking into account the distinctive features of drugs, in which drug expenses are covered by medical insurance only in the physical channel and patients' channel preference is also considered. We find that under certain circumstances, the manufacturer encroachment may lead to a win-win outcome for both the manufacturer and the retailer, contradicting the conventional wisdom that the manufacturer's encroachment into retail space is detrimental to the independent retailer. Additionally, the manufacturer is more likely to encroach when the incurred extra cost is sufficiently small, the perceived quality of the drug selling through the direct channel is sufficiently high and the out-of-pocket percentage cost of the drug selling in the physical channel is high. We further study the impact of manufacturer encroachment on social welfare and find that the introduction of encroachment decreases the social welfare when patients' perceived quality of the drug obtained through the online store is low and improves the social welfare when the perceived quality exceeds a certain threshold.

Trends in the Concentration and Distribution of Health Care Expenditures in the US, 2001-2018

The concentration of health care expenditures has important implications for managing risk pools, drug benefit design, and care management. To examine trends in the concentration of health care spending in different population groups and expenditure categories in the US between 2001 and 2018. This study is a cross-sectional analysis of Medical Expenditure Panel Surveys (MEPS) collected between 2001 and 2018. The MEPS is a household survey of medical expenditures weighted to represent national estimates in the US. Respondents were a nationally representative sample of the US civilian noninstitutionalized population. Data analysis was performed from December 2020 to February 2021. The main outcome is the concentration of health care expenditures as measured by the cumulative percentage of health expenditure vs percentage of ranked population. This study reports trends in the distribution of populations across 4 concentration curve parameters: top 50% expenditure (high spenders), next 49% expenditure (medium spenders), next 1% expenditure (low spenders), and nonspenders. The mean sample size of the MEPS surveys used in the analysis was 34 539 individuals, and the sample size varied between 30 461 and 39 165 individuals over the years studied. On the basis of data from 30 461 MEPS respondents (15 867 women [52.1%]; mean [SD] age, 38.9 [24.0] years) in 2018, the top 4.6% (95% CI, 4.3%-4.9%) of the US population by spending accounted for 50% of health care expenditures. Although this fraction varied across population groups or expenditure categories, it remained remarkably stable over time with one exception: the concentration of spending on prescription drugs. In 2001, one-half of all expenditures on prescription drugs were concentrated in 6.0% (95% CI, 5.6%-6.4%) of the US population, but by 2018, this proportion had decreased to 2.3% (95% CI, 2.1%-2.5%). This change does not appear to be associated with a change in the overall share of prescription drug expenses, which increased by only a small amount, from 20.4% in 2001 to 24.8% in 2018. The overall concentration of health care expenditures remained stable between 2001 and 2018, but these findings suggest that there has been a sharp increase in the concentration of spending on prescription drugs in the US. This coincides with the genericization of many primary care drugs, along with a shift in focus of the biopharmaceutical industry toward high-cost specialty drugs targeted at smaller populations. If this trend continues, it will have implications for the minimum scale of risk-bearing and drug management needed to operate efficiently, as well as the optimal cost-sharing features of insurance products.

Assessment of Medical Expenditure for Patients With Breast Cancer in China: Evidence From Current Curative Expenditure by System of Health Accounts 2011

ObjectivesThe incidence and mortality of breast cancer have been increasing in China and bring heavy economic burdens to patients, families, and society. This study aimed to analyze the structure and influencing factors of inpatient expenditures of patients with breast cancer and put forward suggestions for insurance management. MethodsA multistage stratified random sampling method was used to investigate 379 medical institutions and 7366 pieces of inpatient records of patients with breast cancer in Dalian in 2018. Under the framework of “System of Health Accounts 2011,” the current curative expenditure (CCE) and its distribution were calculated. The relationships between hospitalization expenditure and factors were analyzed by multiple stepwise regression and structural equation modeling. ResultsThe CCE of patients with breast cancer in Dalian in 2018 was ¥273.38 million, accounting for 10.66% of the total expenditure on cancer. The majority of the CCE flowed to large general hospitals. The CCE was concentrated in patients aged 40 to 69 years (23.46%). The hospitalization expenditure correlated positively with length of stay, surgery, and drug expenses (rs = 0.586-0.754, P < .01) and negatively associated with age (rs = −0.074, P < .01). The length of stay mediated the relationship between surgery and hospitalization expenses for patients with breast cancer. The factors that affected the hospitalization expenditure were the drug expenses, surgery, length of stay, insurance status, and institution level. ConclusionsThe cost control for CCE of breast cancer inpatient treatment is crucial in China. Promoting hierarchical diagnosis and treatment, reducing the length of stay, and improving medical insurance depth would be effective measures to reduce the financial burden of patients.

Digital health care in China and access for older people

Digital health care in China and access for older people

PCN48 Cost-Benefit Analysis of Trilaciclib for the Prevention of Chemotherapy-Induced Myelosuppression in Extensive-Stage Small Cell Lung Cancer

Evaluate the net monetary benefit (NMB) of trilaciclib when used to prevent chemotherapy-induced myelosuppression (CIM) in patients with extensive-stage small cell lung cancer (ES-SCLC). A decision tree model was constructed to calculate the NMB associated with trilaciclib, a myelopreservation therapy. Health outcomes and related economic consequences were projected and compared for adult patients receiving trilaciclib or placebo prior to treatment with standard first-line (etoposide, carboplatin, and atezolizumab) or second-line (topotecan) anticancer regimens. Rates of hematologic adverse events (AEs) consequent to CIM and their reduction due to trilaciclib were imputed from trilaciclib clinical trials. Drug expenses were calculated from published wholesale acquisition costs at recommended dosing. AE management costs were obtained from published literature. Quality-of-life measures were derived from patient-reported outcomes data collected in trilaciclib clinical trials, and quality-adjusted-life-year (QALY) was transformed into a monetary value using willingness-to-pay thresholds. The time horizon was set to the duration of each chemotherapy-based regimen during which CIM events were observed. Assumptions and uncertainty in model parameters were tested using sensitivity analyses. Evaluations were undertaken from a US payer perspective and expressed in 2019 USD. Incremental budget expenses associated with add-on trilaciclib therapy were offset by savings attributed to a reduction in the incidence and costs of patients’ CIM-related AEs. Overall healthcare costs were estimated to be $15,014 and $19,642 lower for both first- and second-line recipient populations, respectively. In parallel, the NMB of trilaciclib was computed to be $15,244 and $21,081 for each corresponding cohort at a conservative $50,000/QALY willingness-to-pay when given as a preemptive intervention. Our model predicts the use of trilaciclib prior to chemotherapy leads to positive NMB in patients with ES-SCLC owing to downstream improvements in QALY and reduced healthcare costs. Economically, trilaciclib is a favorably valued innovation for preventing myelosuppression in patients with ES-SCLC.

Drug Utilization for Pain Management during Perioperative Period of Total Knee Arthroplasty in China: A Retrospective Research Using Real-World Data.

Background and Objective: Total knee arthroplasty (TKA) is one of the most painful procedures and perioperative pain usually requires the use of many analgesics to relieve it. The appropriate use of analgesics to relieve patient pain is an important issue of TKA. To characterize the drug utilization for pain management during perioperative period of TKA in China using real-world data of electronic medical records. Materials and Methods: This research used the data of all inpatients who received TKA at 145 hospitals covered 31 provinces in China from 1 January 2016 to 31 December 2018. The exclusion criteria included pregnancy and cancer diagnosis. In the analysis of drug utilization mode (DUM), medicines were classified into 5 groups: non-steroidal anti-inflammatory drugs (NSAIDs), opioids, non-opioid central analgesics, acetaminophen and others. Results: Among the 2017 patients included in this study, there were 1537 (76.20%) female and 480 (23.80%) male, aged 65.77 ± 7.73 years. Regarding the surgery characteristics, 1658 (82.20%) were unilateral; 1220 (60.49%) was graded Level 4; 1312 (65.05%) used local anesthesia as the main anesthesia method, and 1450 (71.89%) lasted for more than 2 h. The most common DUM was “NSAIDs + opioids” (55.92%), followed by “NSAIDs only” (17.85%), and “NSAIDs + Opioids + Non-opioid central analgesics” (17.15%). The results of the Chi-square test showed that differences in DUM were associated with surgery types, surgery levels, surgery duration, and types of anesthesia used. Up to 81.14% of the total drug expenses for pain management was spent on NSAIDs. Due to the limitation of database, this study could not subdivide operation stages, anesthesia methods, dosage forms of drugs. Conclusion: In China, the use of analgesics in perioperative period of TKA was diversified and influenced by a number of surgery characteristics. The rational use of analgesics should be considered in combination with surgery type, surgery level, surgery duration and anesthesia method.

Effects of Chinese medical pricing reform on the structure of hospital revenue and healthcare expenditure in county hospital: an interrupted time series analysis

BackgroundChina has initiated a medical pricing reform to combat the overuse of drugs and relieve the financial burden of patients. This paper aims to analyze the effect of medical pricing reform on revenue structure and healthcare expenditure of county public hospitals in Guangdong province.MethodsBased on the monthly data from January 2013 to August 2019, we use interrupted time series design to evaluate the effects of medical pricing reform on healthcare expenditure in both outpatients and inpatients. A counterfactual is also established to examine the net effect of the policy.ResultsThe proportion of drug revenue decreased from 35 % to 2015 to 29.7 % in 2019, and the revenue from medical services and inspection increased 3.2 and 3 % respectively. Meanwhile, the increasing trend of total expenditure and its main components is slowed down, especially the drug expense and medical consumable expense for inpatients after the Zero Mark-up Drug policy (coefficient = -18.76, p < 0.01; coefficient = -13.41, p < 0.01, respectively). However, the growth of inspection expense for outpatients continues to increase, while the healthcare expenditure for inpatients experiences an instant increase after the Zero Mark-up Medical Consumables policy. In terms of the net effect, most of healthcare expenditure in both outpatient and inpatient experienced a negative net growth from 2015 to 2019.ConclusionsThe medical pricing reform is a valuable attempt in controlling the unreasonable increase of medical expenses. In the meantime, the unexpected increase in inspection expenditure and insufficient compensation from medical service adjustment should draw the attention of the policymakers.

Optimal design of healthcare services after the separation of prescribing and dispensing

Healthcare services are customer-intensive services and usually accompanied by other treatment-related consumptions, e.g. medications. Traditionally in China, prescribing and dispensing are both made by hospitals, which causes high drug expenses. To solve this problem, the Chinese government has begun exploring the separation of prescribing and dispensing. Against this background, this paper analyses the optimal designs for healthcare services considering separated medications. We consider a service system with one monopolistic healthcare service provider, which could be a revenue-maximiser or social-welfare maximiser, and assume patients are bounded-rational with demands affected by price and quality of both service and medications. We analyse the optimal service price and service rate for cases involving either single or multiple medications. Revenue-maximiser usually prefers cost-effective medications, and when its service quality is low, more irrational patients are preferred. Its revenue increases with the number of medication types. For the social-welfare-maximiser, as the number of medication types or improved quality of certain medications does not ensure greater social welfare, its benefits depend on the prices and quality of the entire medications. For a social planner, it is effective to institute price caps to achieve socially optimal results. This paper lays theoretical foundations for price regulations of public healthcare systems.