Medical Savings Research Articles

The Demand for Alternative Forms of Financing Universal Health Care in Canada: A Literature Review

<div class="page" title="Page 32"><div class="layoutArea"><div class="column"><p><span>The discourse surrounding the unsustainability of financing universal health care in Canada has led many stakeholders to evaluate the current system in or- der to consider alternative forms of funding. Several health care financing mod- els have been suggested and include Medical Savings Accounts (MSAs), in- creased taxation and targeting policy to control specific cost drivers such as price inflation of physician and hospital services. This paper targets health care pro- fessionals, researchers and policy makers and calls for more awareness in evalu- ating public health reform initiatives for alternative measures of financing Uni- versal Health Care. Public reform must be critically considered in order to im- prove the cost and delivery of health care services since private methods ulti- mately impede on individual and population determinants of health. Discussed here are alternative financing strategies with an evaluation of benefits, limita- </span><span>tions, and future recommendations for Canada’s health care system. </span></p></div></div></div>

Cost-effectiveness of a new rotavirus vaccination program in Pakistan: A decision tree model

BackgroundRotavirus gastroenteritis places a significant health and economic burden on Pakistan. To determine the public health impact of a national rotavirus vaccination program, we performed a cost-effectiveness study from the perspective of the health care system. MethodsA decision tree model was developed to assess the cost-effectiveness of a national vaccination program in Pakistan. Disease and cost burden with the program were compared to the current state. Disease parameters, vaccine-related costs, and medical treatment costs were based on published epidemiological and economic data, which were specific to Pakistan when possible. An annual birth cohort of children was followed for 5 years to model the public health impact of vaccination on health-related events and costs. The cost-effectiveness was assessed and quantified in cost (2012 US$) per disability-adjusted life-year (DALY) averted and cost per death averted. Sensitivity analyses were performed to assess the robustness of the incremental cost-effectiveness ratios (ICERs). ResultsThe base case results showed vaccination prevented 1.2 million cases of rotavirus gastroenteritis, 93,000 outpatient visits, 43,000 hospitalizations, and 6700 deaths by 5 years of age for an annual birth cohort scaled from 6% current coverage to DPT3 levels (85%). The medical cost savings would be US$1.4 million from hospitalizations and US$200,000 from outpatient visit costs. The vaccination program would cost US$35 million at a vaccine price of US$5.00. The ICER was US$149.50 per DALY averted or US$4972 per death averted. Sensitivity analyses showed changes in case–fatality ratio, vaccine efficacy, and vaccine cost exerted the greatest influence on the ICER. ConclusionsAcross a range of sensitivity analyses, a national rotavirus vaccination program was predicted to decrease health and economic burden due to rotavirus gastroenteritis in Pakistan by ∼40%. Vaccination was highly cost-effective in this context. As discussions of implementing the intervention intensify, future studies should address affordability, efficiency, and equity of vaccination introduction.

Sleeping money: investigating the huge surpluses of social health insurance in China

The spreading of social health insurance (SHI) worldwide poses challenges for fledging public administrators. Inefficiency, misuse and even corruption threaten the stewardship of those newly established health funds. This article examines a tricky situation faced by China's largest SHI program: the basic health insurance (BHI) scheme for urban employees. BHI accumulated a 406 billion yuan surplus by 2009, although the reimbursement level was still low. Using a provincial level panel database, we find that the huge BHI surpluses are related to the (temporarily) decreasing dependency ratio, the steady growth of average wages, the extension of BHI coverage, and progress in social insurance agency building. The financial situations of local governments and risk pooling level also matter. Besides, medical savings accounts result in about one third of BHI surpluses. Although these findings are not causal, lessons drawn from this study can help to improve the governance and performance of SHI programs in developing countries.

The possible impact of an alcohol welfare surcharge on consumption of alcoholic beverages in Taiwan.

BackgroundThe abuse of alcoholic beverages leads to numerous negative consequences in Taiwan, as around the world. Alcohol abuse not only contributes to cardiovascular disease, hypertension, diabetes and cancer, but it is also an underlying cause of many other serious problems, such as traffic accidents, lost productivity, and domestic violence. International leaders in health policy are increasingly using taxation as an effective tool with which to lower alcohol consumption. In this study, we assessed how consumption patterns in Taiwan would be affected by levying a welfare surcharge on alcoholic beverages of 20%, 40% or 60% in accordance with the current excise tax. We also assessed the medical savings Taiwan would experience if consumption of alcoholic beverages were to decrease and how much additional revenue a welfare surcharge would generate.MethodsWe estimated the elasticity of four types of alcoholic beverages (beer, wine, whisky and brandy) using the Central Bureau of Statistics (CBS) Demand Model. Specifically, we estimated alcohol’s price elasticity by analyzing the sales prices and time statistics of these products from 1974 to 2009.ResultsAlcoholic beverages in Taiwan have the following price elasticities: beer (−0.820), wine (−0.955), whisky (−0.587), brandy (−0.958). A welfare surcharge tax of 40% in accordance with the excise tax would decrease overall consumption of beer, wine, whisky and brandy between 16.24% and 16.42%. It would also generate New Taiwan Dollar (NT$) revenues of 5.782 billion to 5.993 billion. Savings in medical costs would range from NT$871.07 million to NT$897.46 million annually.ConclusionsA social and welfare surcharge of 40% on alcoholic beverages in Taiwan would successfully lower consumption rates, decrease medical costs, and generate revenue that could be used to educate consumers and further decrease consumption rates. Consequently, we strongly recommend that such a tax be imposed in Taiwan.

Editorial Policy and Style Information for The ATA Journal of Legal Tax Research

Editorial Policy and Style Information for <i>The ATA Journal of Legal Tax Research</i>

Economic Costs and Benefits of Healthy Eating

Most Americans fail to meet federal dietary recommendations. This may be partly due to the costs of healthy eating. This article reviews the costs and benefits of healthy eating. On the cost side, we discuss food prices, food preparation and other time costs, transportation costs, psychological costs, costs of obtaining nutrition information, and costs of longer life expectancy. We do not summarize these costs with a single dollar value as the current literature does not provide estimates to support such quantification. In terms of benefits, we focus on five health conditions for which poor diet is a major risk factor: coronary heart disease, cancer, stroke, diabetes, and osteoporotic hip fractures. We estimate the benefits of healthy eating in the United States to be $114.5 billion per year (in 2012 dollars) in medical savings, increased productivity, and the value of prolonged life that are associated with reductions in these five conditions.

Does faster rituximab infusion for patients with NHL lower cancer care costs?

e17561 Background: Rituximab in combination with chemotherapy is recommended for non-Hodgkin’s lymphoma. A faster (90-minute) infusion schedule for rituximab has been found to be safe and feasible in NHL patients who tolerate their first infusion administered at the standard rate (Phase III study RATE trial; NCT00719472). This study’s objective was to assess the economic impact of adopting the 90-minute rituximab infusion from a US societal perspective. Methods: The analysis complied with the jointly published Good Research Practice guidelines of the International Society of Pharmacoeconomic and Outcome Research and the Society of Medical Decision Making. The target population was US patients in 2013 with previously untreated diffuse large B-cell lymphoma (DLBCL) or follicular lymphoma (FL) who were scheduled to receive rituximab plus CHOP or CVP. Costs included direct medical costs (drug and administration cost, pre-medication cost, cost of adverse events) and indirect costs (income foregone by patients and informal caregivers due to visit duration for infusion). Data sources included RATE trial, Medicare Fee Schedules, and US Labor Department statistics. Results: Of the 23,519 newly diagnosed DLBCL and FL patients in the target population, the estimated direct medical costs and foregone (patient and caregiver) income for conventional infusion totaled $825,005,088 and $9,293,180 respectively. The 90-minute infusion reduced direct medical costs by $2,205,689 (0.3%) and foregone patient income by $3,628,185 (39%). The average cost savings for each patient was $42 per infusion and $248 per course. The factors that most influenced savings included cost to treat adverse events, administration costs, and patient wage rates. As a result from a shorter infusion duration, the increased center capacity may lead to a larger saving as the fixed center costs can be distributed across more patients. Conclusions: In the context of tremendous focus on affordably improving population health, this study confirms that compared with conventional rituximab infusion regimen, a novel, validated regimen that is 3-4 fold faster to administer and is as safe results in direct medical savings and reduces productivity loss for patients and caregivers.

PIN38 - Potential Medical Cost Savings Associated With Routine Hospital-Based Use Of A Rapid Diagnostic Tool For Bloodstream Infection In The United States

PIN38 - Potential Medical Cost Savings Associated With Routine Hospital-Based Use Of A Rapid Diagnostic Tool For Bloodstream Infection In The United States

The VA: A Precious Resource

This is the 120 Annual Meeting of the Western Surgical Association, one of the oldest surgical societies. This is the 14 meeting of “The Western” in Colorado Springs. In 1997, at our 12 meeting in Colorado Springs, Past President Dr Jack Pickleman’s address to the Western Surgical Association, entitled, “Another Letter to the President,” detailed his concerns about health care to President Clinton. Like virtually all of Jack’s addresses, it was thoughtful, colorful, and entertaining as he detailed proposals for Medicare recipients, medical savings accounts, the Surgeon General’s role in public health, and threats to graduate medical education funding. I have been privileged to serve as your president this year, an honor that I did not deserve though humbly accepted. In this presidential election year, we have heard too many polarizing political statements about our high, though declining, national unemployment rate, the housing crisis that is dissipating, and the slow economy. In spite of these economic and political issues, we are again reminded of our sometimes tenuous earthly existence after witnessing yet another natural disaster in Hurricane Sandy on the East Coast. Today, my objective is to describe a “precious resource” that most of us have experienced and that continues to be a vital part of our profession and discipline. The MerriamWebster online dictionary defines precious as something of “great value or high price,” as “highly esteemed or cherished,” and as “priceless or valuable.” It defines resource as a “source of supply or support,” or as a “natural feature or phenomenon that enhances the quality of human life.” Although I have no conflicts of interest and have no disclosures to make, I do have a passion for this “precious resource,” which has been a major part of my professional life since I was a medical student in the early 1970s. Today, I will speak to you and describe the Veterans Administration (VA). The VA provides a robust and rich environment for the veteran as a patient, the trainee as learnerdwhether

Cost control, Access and Quality of Care: The Impact of IUD Revisit Norms in Ecuador

This paper reports on the results of an operations research study to balance the costs quality of care and access to the Centro Medico de Planificacion Familiar (CEMOPLAF) of Quito Ecuador. The study compared the existing norm of four required revisits to CEMOPLAF with two stimulations: 1) a norm of one required revisit with other revisits optional for clients with problems or questions; and 2) an all revisits optional norm which examines cost-control. To determine the most clinically acceptable and cost-effective norm the study modeled detection of medical problems cost savings and increased new client capacity. Client interviews and medical examinations provided information among IUD users revisiting between January 1 and May 31 1991. Overall results illustrate that the quality cost and access in family planning (FP) programs are interrelated. Program decisions necessarily involve trade-offs so that when administrators seek to improve one aspect they must also consider potential impacts on the other two. Motivated by cost and access concerns the study found that changing the norm would result in a small decrease in quality but major cost savings and improvement in access. Some methodological refinements for research on quality costs and access in FP programs are suggested.

Medical Care Savings From Workplace Wellness Programs

: Workplace wellness programs have become increasingly popular despite large inconsistencies in the analyses of their ability to produce long-term medical care savings. : To clarify the aforesaid situation by estimating potential long-term medical care savings linked to chronic disease. : We combined data from the Global Burden of Disease Study and Medical Expenditure Panel Surveys to estimate the annual savings that would result from lowering risk factors typically managed by workplace wellness programs to their theoretical minimums. : Lowering risk factors to their theoretical minimums, if this were possible, would reduce average annual costs per working-age adult by 18.4%. : These findings have important implications for workplace wellness programs because they provide a robust estimate of potential savings.

Problems and the Potential Direction of Reforms for the Current Individual Medical Savings Accounts in the Chinese Health Care System

Individual health savings accounts are an important part of the current basic medical insurance system for urban workers in China. Since 1998 when the system of personal medical insurance accounts was first implemented, there has been considerable controversy over its function and significance within different social communities. This paper analyzes the main problems in the practical implementation of individual medical insurance accounts and discusses the social and cultural foundations for the establishment of family health savings accounts from the perspective of Chinese Confucian familism. Accordingly, it addresses the direction of the reform and the development of the current system of individual health insurance accounts in China.

Building Social and Economic Capital: The Family and Medical Savings Accounts

Despite the well-documented social, economic, and adaptive advantages for young children, adolescents, and adults, the traditional family in the West is in decline. A growing percentage of men and women choose not to be bound by the traditional moral and social expectations of marriage and family life. Adults are much more likely than in the past to live as sexually active singles, with a concomitant increase in forms of social isolation as well as in the number of children born outside of marriage. These social shifts are also connected to public policies that provide incentives for individuals to exit the family, leaving behind its social, capital, and economic resources. The individualistic character of the social-democratic egalitarian ideology that underlies the current dominant approaches to health care financing in Western Europe and much of North America, for example, is associated with a decline in family stability. Welfare entitlements, including state-based health care, have made it easier to exit the family, undermining the centrality of the family's core human relationships. This essay argues for the importance of recognizing the cardinal role and reality of the family and for the importance of family-based health care savings accounts for preserving family integrity, while also providing for sustainable long-term health care reform.

Does Faster Rituximab Infusion for Patients with NHL Lower Cancer Care Costs?

AbstractAbstract 2063 IntroductionRituximab in combination with chemotherapy is a recommended regimen for non-Hodgkin’s lymphoma (NHL), which has been shown in randomized trials and real-world studies to provide a survival benefit compared with chemotherapy alone. Per the US Prescribing Information (USPI), rituximab is typically administered over 4–6 hours for the first infusion and 3–4 hours for subsequent infusions. A 90-minute infusion schedule for rituximab has been found to be safe and feasible in NHL patients who tolerate their first infusion administered at the standard rate and who do not have significant cardiovascular disease or high circulating lymphocytes. This study’s primary objective was to assess the cost from a US societal perspective of faster 90-minute rituximab infusion vs the conventional 4–6 hour rituximab infusion. MethodsAnalyses were performed in accordance with best research guidelines of the International Society of Pharmacoeconomic Outcomes and Research. The target population was patients with previously untreated diffuse large B-cell lymphoma (DLBCL) or follicular lymphoma (FL) who were scheduled to receive rituximab 375 mg/m2plus CHOP or CVP chemotherapy. Medical resources assessed were: chemotherapy administration, chemotherapy and pre-treatment drugs, and Grade 3/4 adverse events. Indirect costs include societal resources such as income foregone by patients and informal caregivers/spouses as a result of visit duration for infusion. Trial data were used to extract event rates of adverse events and duration of infusions, and patient drop-out rate by cycle. Prices for medical resources were obtained from publicly available Medicare Fee Schedules. Per capita hourly wage rates were extracted from statistics of the US Labor Department. Outcomes were costs per year for patients treated in the US and cost per infusion and per course of therapy in 2012 US dollars. ResultsA projected 23,519 newly diagnosed DLBCL and FL patients comprise the target population. Estimated total direct medical cost for conventional infusion is $925,318,162 and $9,855,416 in foregone income for patients and caregivers. The 90-minute infusion reduced direct medical costs by $22,362,397 (2%) and foregone income for patients and caregivers by $5,115,629 (52%). The average cost savings were $359 per infusion and $2,119 per course. The most influential parameters were administration cost and patient foregone income due to time for infusions. The savings per course may be greater if infusion centers are able to spread fixed costs, e.g., overhead, among a greater number of patients resulting from increased capacity to schedule more patients. ConclusionThe 90-minute rituximab infusion has been found to be a safe and feasible alternative to conventional rituximab infusion for patients with untreated DBLCL or FL. In an era of landmark legislation (The Patient Protection and Affordable Care Act of 2010) designed to address concerns about rising costs of healthcare and place more emphasis on patient-centered research, the faster rituximab infusion regimen offers direct medical savings and reduces foregone income to patients and caregivers. Disclosures:Hornberger:Cedar Associates LLC: Employment; Genentech, A Member of the Roche Group: Research Funding. Off Label Use: Rituxan (Rituximab) - faster infusion is off-label. Dai:Cedar Associates: Employment; Genentech, Inc, A Member of the Roche Group: Research Funding. Goertz:Genentech, Inc, A Member of the Roche Group: Employment, Equity Ownership. Dawson:Genentech, A Member of the Roche Group: Employment, Equity Ownership. Reyes:Genentech, Inc, A Member of the Roche Group: Employment, Equity Ownership.

Future modelling of chronic diseases: foresight and beyond

BackgroundMany chronic diseases are interrelated and their effects under changing exposures need to be better understood. Policy makers and planners need to understand what the current distributions of avoidable chronic disease are, among whom, and how they are likely to develop in the future, particularly their effect on different populations, what will be the health consequences of the extrapolated trends, and how much these consequences can be attenuated with what we currently know and might come to know. Modelling the effects by evidence-based extrapolation, incorporating and attributing the epidemiology of related diseases, can give rise to straightforward estimates of incidence and death rates for the most common related conditions for the next 50 years. This modelling can be done by making basic assumptions about plausible change of risk in disease rates tracking into adulthood using established likelihoods from current trends. These rates in turn are used to compare predicted illness and mortality rates with those that arise from demographic extrapolation from existing current mortality rates. These figures can be used to revise estimates of the healthy working population, by removing death rates and accounting for sickness in a manner that incorporates known and current changes in disease incidence. The model builds on work originally developed for Foresight Tackling Obesities (UK) and subsequent work modelling obesity and related diseases in a further 36 countries. MethodsA microsimulation model was used to project future health of each of possibly millions of individuals with a given demography (of any region) through to a given year, and various scenarios were simulated. Competing risks were examined in real simulated time. Related diseases and associated health-care costs were calculated on the basis of trends in risk factors distributed among these individuals. In the case of obesity, 13 diseases were considered. We simulated three hypothetical future scenarios: no reduction and 1% and 5% reductions in body-mass index (BMI). Ultimately, health and other costs incurred or saved can be compared with the costs of intervention. The simulation model was developed in discrete modules to enable radical change and updating of assumptions and parameters. We did not apply any future discounting for this project. FindingsSmall reductions in risk factors can have substantial effects on future burdens of disease and avoidable health-care costs. In the UK, 1% reduction in BMI rates will save £15·5 billion, whereas in the USA the medical costs will be reduced by US$686 billion. With a 5% reduction in BMI, medical cost savings in the UK will be £61·8 billion and in the USA $1·93 trillion. The figures are substantial for other countries too, reaching $45 million for Russia, $1·8 billion for Mexico, and $4·8 billion for Brazil. All savings will be achieved by 2050. InterpretationThis predictive modelling has significant resonance with policy makers. Using sensitivity analysis we can test the outcome of interventions at a national or subnational level over a timescale that is difficult to measure by conventional evaluative methods. FundingGlaxoSmithKline (grant number 27875780), Robert Wood Johnson Foundation (numbers 260639 and 61468 and 66284), Centers for Disease Control and Prevention (U48/DP00064-00S1 and 1U48DP001946).

Educational Intervention in CKD Retards Disease Progression and Reduces Medical Costs for Patients with Stage 5 CKD

Background: Nephrologist-based multidisciplinary care (MDC) has a positive impact on slowing chronic kidney disease (CKD) progression. However, the benefits of MDC in patients with stage 5 CKD remain unclear. Methods: Stage 5 CKD patients who visited the Chang Gung Memorial Hospital, Chiayi, Taiwan during the period of 2002–2008 were enrolled. The incident dialysis and medical cost were compared between MDC recipients and nonrecipients. The MDC recipients were divided into two groups by educational duration to observe the clinical renal outcome and medical care expenses. The effect of MDC on renal disease progression was also compared in MDC recipients with and without diabetes. Results: Out of 307 patients, 171 received MDC. For MDC recipients, the temporary usage of catheter was reduced (54.7% vs. 79.4%, p < 0.001), the hospital stay was shorter (18.64 ± 1.20 vs. 24.63 ± 1.22 months, p = 0.001), and the total medical cost was lower [New Taiwan dollars (NTD) 105,948.54 ± 9,967.22 vs. NTD 160,388.61 ± 16,373.97, p = 0.005] than for nonrecipients. Out of the 171 MDC recipients, those with MDC for more than 1 year had slower renal disease progression (0.76 ± 0.27 mL/min per 1.73 m2 per year) and had an estimated per- capita annual cost savings of about NTD 336,500.66. MDC recipients with diabetes had a higher risk of requiring dialysis than those without diabetes. Conclusions: MDC could significantly reduce temporary use of the catheter, hospital stay, and total medical costs in patients with stage 5 CKD. Furthermore, longer (>1 year) MDC could preserve renal function and deliver annual medical cost savings.

Look for Comorbidities in Youth With Addiction

Back to table of contents Previous article Next article Professional NewsFull AccessLook for Comorbidities in Youth With AddictionAaron LevinAaron LevinSearch for more papers by this authorPublished Online:15 Jun 2012https://doi.org/10.1176/pn.47.12.psychnews_47_12_5-aAbstractSubstance use is increasing among adolescents, yet existing psychosocial interventions to treat related disorders have shown only modest efficacy.From left: Aaron Hogue, Ph.D., of Columbia University; Kevin Gray, M.D., of the Medical University of South Carolina; and Paula Riggs, M.D., of the University of Colorado School of Medicine discuss new developments in the treatment of adolescents with substance abuse at APA’s 2012 annual meeting in Philadelphia. Comorbidities are common, said Riggs, and treating them may be key to successful treatment of substance abuse.David Hathcox“Adolescents are more vulnerable to addiction in part because of rapid brain development that continues up to the mid-20s,” said Paula Riggs, M.D., a professor of psychiatry and director of the Division of Substance Dependence at the University of Colorado School of Medicine in Denver, at APA’s 2012 annual meeting in Philadelphia in May. “Whatever a teenager does affects brain development and pruning.”Thus, addiction and mental illness frequently both have pediatric-onset and developmental contexts, and each is a risk factor for the other, she said.Despite its benign reputation among the general public, marijuana is especially bad for adolescents because it disrupts development of the prefrontal cortex by way of the CB1 receptor’s regulatory role, she explained.In addition, marijuana alters the reward response to other drugs, disrupts control over glutamate and GABA of the endogenous cannabinoid system, and can predispose vulnerable individuals to schizophrenia and other psychoses.Treatment can be effective, but only about 10 percent of those who need it access care. Too often it produces only modest reductions in drug use, low abstinence, and high relapse rates.One reason for the lack of success in treatment is that comorbidity is common, but treatments integrating behavioral and pharmacotherapy are few, she noted. Many adolescents would also benefit from early intervention, but most are physically healthy and see primary care clinicians too rarely.Comorbidities may be a key to treating the substance abuse.Riggs cited several clinical trials that combined medications with cognitive-behavioral therapy (CBT) to treat patients with drug use and other psychiatric comorbidities (like depression or ADHD). One tested fluoxetine and 16 weeks of CBT versus placebo plus CBT. Although depression remitted more often in patients treated with fluoxetine/CBT (70 percent) compared to placebo/CBT (52 percent), rates of depression remission were higher than expected in both groups, which suggests that CBT targeting substance abuse may have contributed to depression treatment response, said Riggs.Furthermore, patients whose depression remitted, regardless of treatment group, significantly reduced their drug use, while nonremittters did not.“Depression remission may be important to substance treatment outcomes,” she said. “So if depression symptoms don’t significantly decline at the end of the first month of substance treatment, fluoxetine should be considered—and closely monitored—because it appears to be safe and effective even in those not yet abstinent.”Another similarly designed study indicated that OROS-methylphenidate may be both safe and beneficial for ADHD in adolescents concurrently receiving CBT substance treatment, she said. Results of this study also showed greater improvement in some substance treatment outcomes (such as more negative urine drug screens or more days abstinent) in those whose ADHD was treated with OROS/methylphenidate with CBT compared with placebo plus CBT.An integrated treatment approach should begin with a comprehensive psychiatric and substance use diagnostic assessment, including a structured evaluation such as with the Kiddie-Schedule for Affective Disorders and Schizophrenia (KSADS), said Riggs.“Map the temporal and developmental relationships between the onset and progression of substance abuse and psychiatric symptoms,” she said. “Ask about regular use, prior month use, and last use to differentiate use and dependency.”Treatment should begin with nonpharmacological approaches and then proceed, if needed, to monotherapy with proven medications, like fluoxetine, OROS, or naltrexone, depending on the substance. Monitor side effects and compliance, Riggs advised.“Think parsimony and monotherapy,” she said. “I don’t like to see kids on three or four drugs.”Finally, clinicians should work to get the adolescent involved in “pro-social, no-drug activities” to help the young brain develop.Future research should test the efficacy on psychiatric symptoms of CBT targeting substance abuse, she emphasized. Better validated psychological measures and more sophisticated analytic methods are needed, as well. More research on earlier intervention—especially in nontraditional settings like schools—and the medical cost savings that would result would also help.Above all, said Riggs, “We need a comprehensive, team approach using existing community resources.” Watch a video interview with Riggs on YouTube at http://www.youtube.com/watch?v=C301EYY1W9Y. ISSUES NewArchived

Medical Economics Research on Awareness of Community Pharmacists about Raising Pharmaceutical Questions regarding Prescriptions Issued by Physicians

This study examined the impact of pharmaceutical inquiries regarding prescriptions on drug costs by surveying the actual condition of inquiries at 13 pharmacies. The study also investigated the significance of inquiries from a medical economics perspective by calculating the medical cost savings realized by preventing adverse drug reactions (ADRs). As a result, the total change in drug costs for the 13 pharmacies after pharmaceutical inquiries represented an increase of ¥9,018/month. However, upon recalculating the cost of drugs by assuming that those with an "Incomplete entry in the prescription (compared with previous prescription, etc.)" should in fact have been prescribed, and excluding them, the total drug costs for the 13 pharmacies is decreased to ¥154,743/month, translating to a cost-savings of ¥7.2/prescription. The study then undertook a comprehensive assessment based on the Diagnosis Procedure Combination (DPC) system to determine the total medical cost-savings for 5 patients in whom ADRs could have occurred if the prescriptions had not been modified as a result of pharmaceutical inquiries. The obtained figure of ¥1,188,830 suggests that pharmaceutical inquiries contribute to reduced medical costs. The findings of this study indicate that pharmaceutical inquiries regarding prescriptions by staff pharmacists not only ensure the proper delivery of drug therapy to patients, but are also effective from a medical economics perspective.

12-Step participation reduces medical use costs among adolescents with a history of alcohol and other drug treatment

BackgroundAdolescents who attend 12-step groups following alcohol and other drug (AOD) treatment are more likely to remain abstinent and to avoid relapse post-treatment. We examined whether 12-step attendance is also associated with a corresponding reduction in health care use and costs. MethodsWe used difference-in-difference analysis to compare changes in seven-year follow-up health care use and costs by changes in 12-step participation. Four Kaiser Permanente Northern California AOD treatment programs enrolled 403 adolescents, 13–18-years old, into a longitudinal cohort study upon AOD treatment entry. Participants self-reported 12-step meeting attendance at six-month, one-year, three-year, and five-year follow-up. Outcomes included counts of hospital inpatient days, emergency room (ER) visits, primary care visits, psychiatric visits, AOD treatment costs and total medical care costs. ResultsEach additional 12-step meeting attended was associated with an incremental medical cost reduction of 4.7% during seven-year follow-up. The medical cost offset was largely due to reductions in hospital inpatient days, psychiatric visits, and AOD treatment costs. We estimate total medical use cost savings at $145 per year (in 2010 U.S. dollars) per additional 12-step meeting attended. ConclusionsThe findings suggest that 12-step participation conveys medical cost offsets for youth who undergo AOD treatment. Reduced costs may be related to improved AOD outcomes due to 12-step participation, improved general health due to changes in social network following 12-step participation, or better compliance to both AOD treatment and 12-step meetings.

PDB84 Liberalization of Medical Savings Accounts for Outpatient Treatment and Health Care Utilization Among Type 2 Diabetes Mellitus Patients

Hispanic populations. Analyze prevalence, incidence, new patient age, therapy adherence, inferred disease severity, and inferred disease progression. METHODS: Catalina HealthTM receives a nationally representative sample of pharmacy data containing 40% of all US retail prescription volume and 130 million unique patient ID’s. The data is HIPAA compliant, updated daily, longitudinal, and not projected. Select a cohort of patients (40% random sample) filling diabetes scripts in the 1st quarter of 2007 in zip codes with low ( 3%) or high (25% ) Hispanic population based on US census data. Overall the high group averages 50% Hispanic. Use a 1 year look-back period, and follow the patient cohort for 4 years. Consider patients adherent when Proportion of Days Covered (PDC) 80%. RESULTS: Diabetes patients available for analysis varied by metric: prevalence (478k), incidence (58k), adherence (31K). Logistic regression adjusting for covariates, or ANCOVA models are fit depending upon the metric. Covariates include average age of all patients visiting the pharmacy, proportion female, state, retailer chain, median income of the pharmacy’s zip code, and rural zip code designation. Patients in high Hispanic populations have 26% greater prevalence of diabetes (OR 1.26, p-value 0.0001), and 25% greater incidence (OR 1.25, p-value 0.0001). Additionally, they are 20% less likely to be adherent to therapy after 24 months (OR 0.80, p-value 0.0005), and 17% less likely after 48 months (OR 0.83, p-value 0.0055). CONCLUSIONS: High Hispanic populations have significantly higher incidence and prevalence of diabetes. They are also significantly less adherent to therapy. No differences are seen in age of new diabetes patients, inferred disease severity, or inferred disease progression. Culturally relevant diabetes education should be provided in US geographies with high Hispanic populations.