Prescription Costs Research Articles

Healthcare costs and resource utilization in patients with migraine treated with erenumab: A retrospective, non-interventional study using claims data from the United States.

To assess healthcare costs and healthcare resource utilization (HCRU) among adult patients who newly initiated erenumab in the United States. This retrospective, non-interventional analysis included adult patients (aged ≥18 years) newly initiating erenumab and who had three consecutive monthly claims for erenumab (11/1/2017-9/1/2019) from the Komodo Health database. Outcomes included migraine-related and all-cause costs, use of other preventive/acute migraine medications, and HCRU. All outcomes were compared during the 180-day pre- versus the 180-day post-index periods. Cost outcomes were also assessed for longer periods including post-index Days 91-270 and monthly mean post-index costs for the longest time of continuous insurance enrollment. Overall, 1839 patients with migraine were included for analysis. Compared to the 180-day pre-index period, an increase in total migraine-related costs (+$2639; p < 0.0001), migraine-related prescription costs (+$3435, p < 0.0001), all-cause total costs (+$2977; p < 0.001), and all-cause prescription costs (+$4102; p < 0.0001) were observed during the 180-day post-index period after adjusting for covariates. Conversely, reduction in migraine-related medical costs (-$896; p < 0.0001), and significantly lower odds of migraine-related emergency room visits (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.44-0.82; p = 0.001), migraine-related office visits (OR 0.58, 95% CI 0.53-0.64; p < 0.0001), and migraine-related neurologist visits (OR 0.69, 95% CI 0.63-0.75; p < 0.0001) were observed during the 180-days post-index period. There were significant decreases in the odds of having overall preventive migraine medications (OR 0.81, 95% CI 0.75-0.87; p < 0.0001), acute-migraine medications (OR 0.92, 95% CI 0.85-1.00; p = 0.038), and triptan (OR 0.79, 95% CI 0.73-0.85; p < 0.0001) during the 180-day post-index period. Sensitivity analyses on cost outcomes found no statistically significant differences in pre-index migraine-related costs compared to post-index migraine-related costs when assessing longer post-index follow-up periods. Initiation of therapy with a novel treatment is often associated with an increase in overall healthcare costs due to the entrance costs associated with novel therapy. For a chronic condition such as migraine, cost versus health benefits should be evaluated over a long period (e.g., ≥2 years) to better understand the true benefits of therapy. Data from this study suggest that the entrance cost for erenumab, the primary driver of the high post-index prescription costs gets mitigated by reduced medical costs over long-term follow-up. The results indicate better disease management in adult patients with migraine, which should be an important consideration for both patients and payors, as these findings have shown an offset between migraine-related prescription and medical costs.

The COVID-19 impact on severe uncontrolled asthma costs and biologic use.

Background: Patients with severe uncontrolled asthma (SUA) overwhelmingly contribute to the economic burden of asthma and may require biologic therapy. However, the impact of the CoronaVirus Disease of 2019 (COVID-19) on asthma costs and biologic use has yet to be evaluated. Objective: The objective was to test the hypothesis that SUA costs and biologic use decreased during the pandemic. Methods: We analyzed medical costs and biologic use in patients with SUV from January 2017 to December 2021, by using claims data from a large managed care organization and electronic health record data from Robert Wood Johnson Barnabas Health, according to provider specialty. Results: Of the 3817 managed care organization enrollees within Robert Wood Johnson Barnabas Health with a primary diagnosis of asthma, 348 were identified as having SUA. A nested sample of 151 patients revealed that 50% were managed by primary care physicians (PCP) and specialists, 43% by PCPs only, and 4% by specialists only. The total costs of the claims were $10.8 million over 5 years ($2.2 million per year), with 60% generated from patients seeing PCPs and specialists, 27% from PCPs only, and 15% from specialists only. During the pandemic, total average costs decreased for all care groups (34% PCP-only patients and 45% for both specialist-only and PCP and specialist patients). Inpatient and outpatient costs also decreased and were lowest for patients who saw specialists and highest for patients who saw PCPs and specialists. In contrast, prescription costs increased during the pandemic. Biologic use was steadily increasing until a twofold decrease was observed during the pandemic. Thirteen patients were on biologics: two were managed by PCPs, four by specialists, and seven by both. Conclusion: Inpatient and outpatient costs decreased during the COVID-19 pandemic, but prescription costs increased. Biologic use was increasing among patients with SUA before the pandemic but then drastically decreased and remained lower during the observational interval.

Impact of an enhanced recovery after surgery program with a multimodal analgesia care pathway on opioid prescribing and clinical outcomes for patients undergoing colorectal surgery

Background Opioids are a mainstay for acute pain management, but their side effects can adversely impact patient recovery. Multimodal analgesia (MMA) is recommended for treatment of postoperative pain and has been incorporated in enhanced recovery after surgery (ERAS) protocols. The objective of this quality improvement study was to implement an MMA care pathway as part of an ERAS program for colorectal surgery and to measure the effect of this intervention on patient outcomes and costs. Methods This pre-post study included 856 adult inpatients who underwent an elective colorectal surgery at three hospitals within an integrated healthcare system. The impact of ERAS program implementation on opioid prescribing practices, outcomes, and costs was examined after adjusting for clinical and demographic confounders. Results Improvements were seen in MMA compliance (34.0% vs 65.5%, P < 0.0001) and ERAS compliance (50.4% vs 57.6%, P < 0.0001). Reductions in mean days on opioids (4.2 vs 3.2), daily (51.6 vs 33.4 mg) and total (228.8 vs 112.7 mg) morphine milligram equivalents given during hospitalization, and risk-adjusted length of stay (4.3 vs 3.6 days, P < 0.05) were also observed. Conclusions Implementing ERAS programs that include MMA care pathways as standard of care may result in more judicious use of opioids and reduce patient recovery time.

Impact of health system specialty pharmacies on total cost of care in cancer treatment, a multisite review.

Integrated delivery networks can use medically integrated dispensing of oral oncolytics on site through health system specialty pharmacies. There is little published research examining cost savings. Our objective was to demonstrate the financial value of health system specialty pharmacies among patients receiving oral oncolytics dispensed through fully, partially, and non-integrated dispensing strategies. This was a retrospective cohort study of adult patients from Symphony Health's Integrated Dataverse® repository who filled a prescription for an agent of interest from 7/1/16-6/30/20 that was written within 25 US health systems. Outcomes included costs, healthcare resource utilization, and duration of therapy. In total, 36,816 patients were included; 986 patients (2.7%) integrated, 1,822 (4.9%) partially integrated, and 34,008 (92.4%) non-integrated. Mean 6-month medical charge and oncolytic prescription costs were lower for the integrated group ($36,831; $55,786) than the partially integrated ($46,304, p = 0.053; $63,295, p = 0.071) and non-integrated groups ($54,261, p < 0.001; $65,005, p = 0.004). In most healthcare resource utilization categories, the integrated group had the lowest patient percentage utilizing medical care. Duration of therapy was lower on average by ∼3 months in the integrated vs non-integrated group, which may represent closer monitoring of patient medical records and need for fills vs autoship practices. Patients receiving oral oncolytics through medically integrated dispensing at health system specialty pharmacies may have lower medical and pharmacy costs and decreased healthcare resource utilization. This study adds to the growing body of literature supporting integrated delivery networks and integrated dispensing. Further research is needed to demonstrate the value of medically integrated dispensing through health system specialty pharmacies in the delivery of treatment to patients with cancer and other high-cost diseases.

The Impact of a Digital Weight Loss Intervention on Health Care Resource Utilization and Costs Compared Between Users and Nonusers With Overweight and Obesity: Retrospective Analysis Study.

The Noom Weight program is a smartphone-based weight management program that uses cognitive behavioral therapy techniques to motivate users to achieve weight loss through a comprehensive lifestyle intervention. This retrospective database analysis aimed to evaluate the impact of Noom Weight use on health care resource utilization (HRU) and health care costs among individuals with overweight and obesity. Electronic health record data, insurance claims data, and Noom Weight program data were used to conduct the analysis. The study included 43,047 Noom Weight users and 14,555 non-Noom Weight users aged between 18 and 80 years with a BMI of ≥25 kg/m² and residing in the United States. The index date was defined as the first day of a 3-month treatment window during which Noom Weight was used at least once per week on average. Inverse probability treatment weighting was used to balance sociodemographic covariates between the 2 cohorts. HRU and costs for inpatient visits, outpatient visits, telehealth visits, surgeries, and prescriptions were analyzed. Within 12 months after the index date, Noom Weight users had less inpatient costs (mean difference [MD] -US $20.10, 95% CI -US $30.08 to -US $10.12), less outpatient costs (MD -US $124.33, 95% CI -US $159.76 to -US $88.89), less overall prescription costs (MD -US $313.82, 95% CI -US $565.42 to -US $62.21), and less overall health care costs (MD -US $450.39, 95% CI -US $706.28 to -US $194.50) per user than non-Noom Weight users. In terms of HRU, Noom Weight users had fewer inpatient visits (MD -0.03, 95% CI -0.04 to -0.03), fewer outpatient visits (MD -0.78, 95% CI -0.93 to -0.62), fewer surgeries (MD -0.01, 95% CI -0.01 to 0.00), and fewer prescriptions (MD -1.39, 95% CI -1.76 to -1.03) per user than non-Noom Weight users. Among a subset of individuals with 24-month follow-up data, Noom Weight users incurred lower overall prescription costs (MD -US $1139.52, 95% CI -US $1972.21 to -US $306.83) and lower overall health care costs (MD -US $1219.06, 95% CI -US $2061.56 to -US $376.55) per user than non-Noom Weight users. The key differences were associated with reduced prescription use. Noom Weight use is associated with lower HRU and costs than non-Noom Weight use, with potential cost savings of up to US $1219.06 per user at 24 months after the index date. These findings suggest that Noom Weight could be a cost-effective weight management program for individuals with overweight and obesity. This study provides valuable evidence for health care providers and payers in evaluating the potential benefits of digital weight loss interventions such as Noom Weight.

Economic Trends in Commonly Used Drugs for Spinal Fusion and Brain Tumor Resection: An Analysis of the Medicare Part D Database.

With the incidence of central and peripheral nervous system disorders on the rise, neurosurgical procedures paired with the careful administration of select medications have become necessary to optimize patient outcomes. Despite efforts to decrease the over-prescription of common addictive drugs, such as opioids, prescription costs continue to rise. This study analyzed temporal trends in medication use and cost for spinal fusion and brain tumor resection procedures. The Medicare Part B Database was queried from 2016 to 2020 for data regarding spinal fusion and brain tumor resection procedures, while the Part D Database was used to extract data for two commonly prescribed medications for each procedure. Pearson's correlation coefficient and linear regression were completed for the analyzed variables. The results showed a significant negative correlation between the number of spinal procedure beneficiaries and the cost of methocarbamol, as well as between the annual percent change in spinal beneficiaries and the annual percent change in oxycodone cost. Linear regression revealed that oxycodone cost was the only parameter with a statistically significant model. Moving forward, it is imperative to combat rising drug costs, regardless of trends seen in their usage. Further studies should focus on the utilization of primary data in a multi-center study.

A 6-Year Review of the Electronic Drug Prescription System in the Republic of Türkiye

Pharmacoepidemiological studies are important for the development of health systems. The aim of this study is to examine the seasonal and branch changes of prescriptions written in the light of national data. Drug and prescription information between 01.01.2016 and 31.12.2022 analyzed retrospectively from electronic data. In addition to gender and age distribution, the specialty and hospital level at which the prescription was written were examined in temporal terms. Prescribed drugs have been classified according to Anatomical Therapeutic Chemical (ATC) codes previously created by the World Health Organization. It was determined that 1,452,128,177 prescriptions were written during the study period. These included a total of 4,602,556,489 drugs with the ATC code. The most written ATC code group was A (alimentary tract and metabolism), followed by M (musculo-skeletal system), and R (respiratory system) group drugs. In terms of specialization, the group that wrote the most prescriptions was family physicians, followed by emergency physicians, and internal medicine specialists. Examining prescription software trends is important when creating healthcare policies. Developing strategies to reduce prescription costs will contribute to the efficient use of resources and improving the quality and sustainability of health services delivery.

Post-Thyroidectomy Hypocalcemia: Incidence, Prediction, and Outpatient Management Strategies Based on PTH and Calcium Levels

PTH measurement has been proposed to predict transient and permanent postoperative hypocalcemia. There is no standard cut-off point or time for sampling. To report the incidence of post-thyroidectomy hypocalcemia in a high-volume surgical group and propose an outpatient management protocol according to postoperative (PO) calcium levels, iPTH (normal, low, or undetectable), and symptoms. Furthermore, determine postoperative PTH values as predictors of hypocalcemia. In 106 patients with total thyroidectomy between 2019 and 2021, pre-and postoperative levels of calcium, magnesium, phosphorus, and iPTH were measured. Transient (< 12 months) and permanent (> 12 months) hypocalcemia was observed in 29% and 1%. Cut-off points to predict hypocalcemia were PTH < 8.8 pg/mL and < 80% decrease in % PTH (d% PTH) the day after surgery. With the proposed management, early discharge is indicated (an average of 1.05 days), and the prescription cost is limited. There is no significant association between PO hypomagnesemia and hyperphosphatemia with PO hypocalcemia. The most widely used treatment is exclusive calcium carbonate (schemes I and II). Patients remain with mild symptoms at two weeks PO in 5% and discontinue oral treatment in 93% in this period. Protocols for measuring PTH as a hypocalcemia predictor vary. Each center must know and establish its management protocols. With this experience, we demonstrate the usefulness and safety of a management scheme based on calcium, PTH (normal, low, or undetectable), and symptoms with an indication of prophylactic treatment for all patients and a safe outpatient setting at a lower cost than prolonged hospitalization.

BH09 Patient experience of off-label Janus kinase inhibitor use for alopecia areata in a cohort of 34 patients from a single UK practitioner: exploring changing trends in healthcare provision and access to drug treatments

Abstract We present data from a UK cohort of patients with alopecia areata (AA) who have sought Janus kinase inhibitor (JAKi) treatments prior to National Health Service funding. We have explored referral methods, access to consultations, and shared care in monitoring and acquisition of medication both from the UK and abroad. We have looked at the drugs and dosage, adjuvant therapies and response to treatment, and report data on side-effects and reasons for changing drugs or stopping treatment. Thirty-four patients (25 adults and nine children) self-referred to a UK-based private hair clinic for JAKi treatment over a period of 36 months. The median age of patients was 40 years (interquartile range 18–50). The patients sought treatment from a wide geographical area in the UK, with one patient living 400 miles from the clinic. Seventeen (50%) and 14 (41%) patients were prescribed baricitinib and tofacitanib, respectively, with three (9%) patients prescribed both. Nineteen (56%) patients had severe alopecia with &amp;gt; 95% hair loss. Social media, in particular a closed Facebook group, was an important source of referral and information on sourcing medication from abroad. Nine per cent of consultations were virtual (telephone/video). The cost of treatment varied from £100 per month to £1400, with a large difference between UK-sourced medication and that from abroad. Eight (24%) patients showed no scalp regrowth response to first-line treatment, despite dose escalation, with one subsequently experiencing total hair regrowth on swapping to a different JAKi class. One patient had to stop treatment after developing breast cancer. JAKi are an exciting and emerging treatment for AA that are yet to be widely prescribed by UK practitioners. However, the response to JAKi is not universal. Owing to the cost of private prescription, patients are choosing to source JAKi from abroad. Our study presents data on how the alopecia community has helped inform patients about treatment access.

Evaluation of 340B prescription assistance program on healthcare use in chronic obstructive pulmonary disease

BackgroundThe federal 340B drug program was designed to stretch scarce federal resources to provide more comprehensive services for more eligible patients. To help satisfy community needs, 340B Prescription Assistance Programs (PAPs) allow eligible patients to access medications at significantly reduced costs. ObjectivesTo measure the impact of reduced-cost medications for chronic obstructive pulmonary disease (COPD) through a 340B PAP on all-cause hospitalizations and emergency department visits. MethodsThis multi-site, retrospective, single-sample, pre-post cohort study involved patients with COPD who used a 340B PAP to fill prescriptions for an inhaler or nebulizer between April 1, 2018, and June 30, 2019. Data from included subjects were evaluated and compared in the year before and after each individual patient's respective prescription fill in the 340B PAP. The primary outcome evaluated the impact of 340B PAP on all-cause hospitalizations and emergency department visits. Secondary outcomes evaluated the financial impact associated with program use. Wilcoxon signed-rank test was utilized to assess changes in the outcome measures. ResultsData for 115 patients were included in the study. Use of the 340B PAP resulted in a significant reduction in the composite mean number of all-cause hospitalizations and emergency department visits (2.42 vs 1.66, Z = −3.12, p = 0.002). There was an estimated $1012.82 mean cost avoidance per patient due to reduction in healthcare utilization. Annual program-wide prescription cost savings for patients totaled $178,050.21. ConclusionsThis study suggested that access to reduced-cost medications through the federal 340B Drug Pricing Program was associated with a significant reduction in hospitalizations and emergency department visits for patients with COPD, decreasing patients' utilization of healthcare resources.

Rationale Treatment of GERD During Pregnancy: A Prescription Audit Using who Core Drug use Indicators

Background: GERD is a common condition worldwide. It is also frequently seen during pregnancy due to hormonal changes and increasing intra-abdominal pressure. Treatment is usually focused on resolving symptoms. In this regard life style modification and pharmacological interventions are done. But prescribing during pregnancy is a risk benefit condition. Irrational prescribing is a routine practice nowadays. Prescribing during pregnancy needs more care. To avoid hazards associated with irrational prescribing WHO has developed five indicators. Aim and objective: This study was designed to find out prescription mistakes during pregnancy using WHO core drug use indicators. To provide clinicians with prescribing guidlines in order to avoid future discrepancies while prescribing. Method: It was a cross sectional study. Data was obtained from outpatient obstetric departments and analyzed. Result: Antacids, PPIs, Ranitidine and metoclopramide were frequently used drugs. All drug classes are present in essential drug list of Pakistan 2021.Only 8% of the total drugs were prescribed by generic name. Number of drugs per encounter was minimum 5%.Number of injections per encounter was also within standard range 23%. About 20% of prescription were expensive which is a high cost for an under developing country like Pakistan. Practical implication: Good prescribing puts positive impact on patient’s physical and mental health. Conclusion: There should be a shift of prescription from brand name to generic name. Control of prescription cost is another issue highlighted. WHO core drug use indicators are only limited to outpatient Departments. These are of limited value for in doors patients where drug prescriptions are more complex. Keywords: Drug use WHO Drug use, GRED, Pregnancy, Pakistani Women

PRESCRIPTION COST ANALYSIS IN PATIENTS OF TYPE 2 DM AND HYPERTENSION JOINING CHRONIC DISEASE MANAGEMENT PROGRAM (PROLANIS) AT PUSKESMAS AFTER THE IMPLEMENTATION OF NATIONAL HEALTH INSURANCE

To improve the status of public health and carry out social security programs in the health sector, the government started to implement the National Health Insurance. This program covers the participants’ medical care expenses using the capitation system applied in health centers as the First-Level Health Facilities. BPJS Kesehatan has allocated some budget in the form of a capitation rate to first-level health facilities for hypertension and type 2 diabetes mellitus patients after the implementation of National Health Insurance. This research was carried out in 4 health centers, namely Lamper Tengah Health Center, Mangkang Health Center, Mijen Health Center, and Karanganyar Health Center. The data were collected retrospectively from the medical records of 800 patients. The data were analyzed descriptively to determine the prescription cost and Spearman's rho test was used to find the factors that influence the prescription cost. It was revealed that the average prescription cost for type 2 DM patients was IDR 142,293, and for hypertensive patients was IDR 112,735. The prescribing pattern in patients covered by Prolanis program for type 2 DM patients is a combination of glimepiride, metformin with a drug price of IDR 20,670. Factors that have an influence on prescription costs are diagnosis p= 0.033, type of drug (p= 0.000) and drug item (p= 0.000). This study concludes that the factors to influence the drug costs of Prolanis patients at the health centers of Semarang City were the patient's diagnosis, the type of drug given, and the number of drug items given.

Association of Prescription Co-payment With Adherence to Glucagon-Like Peptide-1 Receptor Agonist and Sodium-Glucose Cotransporter-2 Inhibitor Therapies in Patients With Heart Failure and Diabetes

Type 2 diabetes (T2D) and heart failure (HF) prevalence are rising in the US. Although glucagon-like peptide-1 receptor agonists (GLP1-RA) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve outcomes for these conditions, high out-of-pocket costs may be associated with reduced medication adherence. To compare 1-year adherence to GLP1-RA and SGLT2i therapies by prescription co-payment level in individuals with T2D and/or HF. This retrospective cohort study used deidentified data from Optum Insight's Clinformatics Data Mart Database of enrollees with commercial and Medicare health insurance plans. Individuals aged 18 years or older with T2D and/or HF who had a prescription claim for a GLP1-RA or SLGT2i from January 1, 2014, to September 30, 2020, were included. Prescription co-payment, categorized as low (<$10), medium ($10 to<$50), and high (≥$50). The primary outcome was medication adherence, defined as a proportion of days covered (PDC) of 80% or greater at 1 year. Logistic regression models were used to examine the association between co-payment and adherence, adjusting for patient demographics, medical comorbidities, and socioeconomic factors. A total of 94 610 individuals (mean [SD] age, 61.8 [11.4] years; 51 226 [54.1%] male) were prescribed GLP1-RA or SGLT2i therapy. Overall, 39 149 individuals had a claim for a GLP1-RA, of whom 25 557 (65.3%) had a PDC of 80% or greater at 1 year. In fully adjusted models, individuals with a medium (adjusted odds ratio [AOR], 0.62; 95% CI, 0.58-0.67) or high (AOR, 0.47; 95% CI, 0.44-0.51) co-payment were less likely to have a PDC of 80% or greater with a GLP1-RA compared with those with a low co-payment. Overall, 51 072 individuals had a claim for an SGLT2i, of whom 37 339 (73.1%) had a PDC of 80% or greater at 1 year. Individuals with a medium (AOR, 0.67; 95% CI, 0.63-0.72) or high (AOR, 0.68; 95% CI, 0.63-0.72) co-payment were less likely to have a PDC of 80% or greater with an SGLT2i compared with those with a low co-payment. In this cohort study of individuals with T2D and/or HF, 1-year adherence to GLP1-RA or SGLT2i therapies was highest among individuals with a low co-payment. Improving adherence to guideline-based therapies may require interventions that reduce out-of-pocket prescription costs.

Making sense of the dollars: Evaluation of financial toxicity in patients of breast medicine receiving oral chemotherapy at Roswell Park.

e18519 Background: Increasing costs of oral chemotherapy have become a significant barrier to cancer care with the potential to cause treatment abandonment and noncompliance. The primary objective of this study is to evaluate the financial toxicity of oral chemotherapy in the Breast Medicine Service at Roswell Park Comprehensive Cancer Center (RPCCC). Methods: This was a retrospective chart review of patients at RPCCC who were diagnosed with breast cancer and prescribed oral chemotherapy between 8/1/21 - 7/31/22. The primary outcome evaluated was average out-of-pocket (OOP) cost of an oral chemotherapy prescription. Secondary outcomes studied included 1) the number of patients enrolled in manufacturer patient assistance programs (PAPs), copay cards, foundation grants, and/or New York State Elderly Pharmaceutical Insurance Coverage (EPIC) program, and 2) median days to treatment start date, approval of prior authorization (PA) and/or PAPs. For patients who filled at outside pharmacies, days to first insurance claim were collected and compared to days to first fill for patients who filled at Roswell Park Pharmacy. Results: A total of 116 patients with a median age of 64 and 122 oral chemotherapy prescriptions were included. Majority of the patients were white (n = 93; 80%) and enrolled in Medicare managed plans (n = 58; 50%). Palbociclib (n = 47; 39%) and capecitabine (n = 29; 24%) were most commonly prescribed. 49 patients filled at Roswell Park Pharmacy; average OOP cost was $48.00 (range: 0-2239.50) per prescription claim. Average OOP cost was $85.18 for patients with Medicare managed plans, $23.35 for patients with commercial insurance, and $3.66 for patients with government-funded insurance. Twenty patients (17%) enrolled in PAPs, foundation grants, copay cards, and/or EPIC program. OOP costs prior to any financial assistance was available for thirteen patients; median OOP cost was $2491.51 (403.62-18165.94). Median days to approval of PAPs and approval of PA was 10 (1-50) and 0 (0-14), respectively. When filling internally at Roswell Park Pharmacy, median days to treatment start date was 6 (0-61) compared to 9 (0-67) for those who filled at outside pharmacies. There was a significant difference (p = 0.0111) between the median days to first fill for patients who filled at Roswell Park Pharmacy (0 days [0-25]) and the median time to first insurance claim (2 days [0-20]) for patients filling at outside pharmacies. Conclusions: Despite utilization of financial assistance program, OOP costs remain high for cancer patients. Having a defined workflow to screen and identify patients at risk for financial toxicity and the ability to refer to appropriate resources to mitigate OOP costs promptly is vital to prevent delays in treatment. Utilizing an integrated health-system specialty pharmacy can be helpful to streamline patient access and avoid further treatment delays.

EE467 Prescription Patterns and Estimation of Cost of Illness of Type-II Diabetic Patients in a Tertiary Care Hospital Nepal

The impact of diabetes on health care expenditures has been increasingly recognized. Number of ‘cost of illness’ studies has shown a threefold increase in the direct costs of diabetic patients compared with non-diabetic patients. This study aimed to evaluate the prescription patterns and cost of illness of type II diabetic patients along with the trends in anti-diabetic and antihypertensive drug use patterns among patients with type II diabetes patients with and without comorbidities.

Effect of colorectal cancer screening on 1-year mortality and medical costs: Real-world evidence from the largest commercial medical claims database in the US.

10579 Background: Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in the United States with increasing trends in both mortality and incidence in individuals under age 50. Whether CRC screening reduces mortality recently becomes controversial in some observational studies due to a lack of data and a possibility of screenings confounded with social determinants of health (SDoH) and patient characteristics that were not properly addressed. Methods: We used the Optum’s de-identified Clinformatics Data Mart Database that provides information of healthcare plan, major SDoH, the CRC diagnosis, treatments, medical service and prescription charges, and survival data since 2007 for over 75 million patients to re-examine benefits of CRC screenings. Our CRC study cohort (N=99,704) included persons first diagnosed with CRC between 2010 – 2020, with 3-year pre-diagnosis continuing insurance coverage to identify pre-diagnosis screening, and 1-year follow-up to identify death and associated costs. Primary outcomes are 1-year mortality, the post-diagnosis medical and prescription cost increments, and health plan change after CRC diagnosis. Augmented inverse probability weighting (AIPW) models were employed to estimate the benefits of CRC screening, adjusting the probabilities of pre-diagnosis screenings due to insurance cover types (commercial/employer, Medicare advantage, and dual Medicare-Medicaid or low-income subsidy (LIS) covers), and healthcare plans (pre-paid, only-in-network, pay-less in-network, and fee-for-service plans), ages, sex, race, residential states, and calendar year. Results: In the study cohort, 37.8% have pre-diagnosis screening records, 18% died within 1 year. Women, persons under age 45, and persons with dual covers were more present in the non-screening group than the screening one. CRC screening was associated with a significant reduction of one-year mortality after adjusting for age, sex, race, health plans, and other factors (death rates in the non-screening group vs the screening one were 23% vs 12%, adjusted OR = 0.57, 95%CI = 0.55 - 0.59). Persons with no screening records experienced higher one-year medical cost increases than those who had pre-diagnosis screenings (17.8% vs 14.8%). No significant difference in health plan changes and/or disruption among the two groups was obvious for persons having either dual- or commercial-cover beneficiaries, yet the screenings slightly induced more these plan changes in the Medicare advantage beneficiaries (OR = 1.06, 95%CI = 1.01 - 1.11). Conclusions: The real-world evidence from the US largest medical claims database suggested that, after adjusting for the screening probability due to healthcare plans and other confounders, CRC screening dramatically reduced one-year death risk, and slightly eased the 1-year financial burdens after CRC diagnosis.

Opioid prescriptions and patients' health services utilization and cost before and during the COVID-19 pandemic: an exploratory population-based administrative data analysis.

The objective was to explore percentages of the population treated with prescribed opioids and costs of opioid-related hospitalizations and emergency department (ED) visits among individuals treated with prescription opioids and costs of all opioid-related hospitalizations and ED visits in the province (i.e., provincial costs) before and during the coronavirus disease 2019 (COVID-19) pandemic in Alberta, Canada. In administrative data, we identified individuals treated with prescription opioids and opioid-related hospitalizations and ED visits among those individuals and among all individuals in the province between 2015/16 and 2021/22 fiscal years. Services used were counted on an item-by-item basis and costed using case-mix approaches. Annually, from 9.98% (2020/21-2021/22) to 14.52% (2017/18) of the provincial population was treated with prescription opioids. Between 2015/16 and 2021/22, annual costs of opioid-related hospitalizations and ED visits among individuals treated with prescription opioids were ∼$5 and ∼$2 million, respectively. In 2020/21-2021/22, the provincial costs of opioid-related hospitalizations (∼$14 million) and ED visits (∼$7.0 million) were almost twice the costs observed in 2015/16 and immediately before the pandemic (2019/20). Our findings suggest that increases in the opioid-related utilization of inpatient and ED services between 2015/16 and 2021/22, including the drastic increases observed during the COVID-19 pandemic, were likely driven by unregulated substances.

Irrational prescription and its costs in neonatal surfactant therapy: public and private hospitals of Iran in 2018

BackgroundIrrational prescription and its subsequent costs are a major challenge worldwide. Health systems must provide appropriate conditions for the implementation of national and international strategies to prevent irrational prescription. The aim of the present study was to determine the irrational surfactant prescription among neonates with respiratory distress and the resulting direct medical costs for private and public hospitals in Iran.MethodsThis was a cross-sectional descriptive study performed retrospectively using data belonged to 846 patients. Initially, the data were extracted from the patients’ medical records and the information system of the Ministry of Health. The obtained data were then compared with the surfactant prescription guideline. Afterward, each neonatal surfactant prescription was evaluated based on the three filters listed in the guideline (including right drug, right dose, and right time). Finally, chi-square and ANOVA tests were used to investigate the inter-variable relationships.ResultsThe results showed that 37.47% of the prescriptions were irrational and the average costs of each irrational prescription was calculated as 274.37 dollars. It was estimated that irrational prescriptions account for about 53% of the total surfactant prescription cost. Among the selected provinces, Tehran and Ahvaz had the worst and the best performance, respectively. As well, public hospitals outperformed private hospitals in terms of the in drug selection, but they underperformed them in terms of the right dose determination.ConclusionThe results of the present study are considered as a warning to insurance organizations, in order to reduce unnecessary costs caused by these irrational prescriptions by developing new service purchase protocols. Our suggestion is the use of educational interventions to reduce irrational prescriptions due to drug selection as well as using computer alert approaches to reduce irrational prescriptions caused by wrong dose administration.

Cost of inappropriate prescriptions for uncomplicated malaria in Ghana

BackgroundMalaria remains a common course of morbidity in many sub-Saharan African countries. While treatment options have improved in recent times, inappropriate prescription seems conventional among providers, increasing the burden on patients and society. This study examined the cost of inappropriate prescriptions for uncomplicated malaria treatment in Ghana.MethodsThis study used retrospective data collected from January to December 2016 in 27 selected facilities, under different ownership in three regions of the country, mainly Volta, Upper East and Brong Ahafo. Stratified random sampling technique was used to extract 1625 outpatient folders of patients diagnosed and treated for malaria. Two physicians independently reviewed patient folders according to the stated diagnoses. Malaria prescriptions were described as inappropriate when they do not adhere to the standard treatment guidelines. The economic cost was mainly treatment cost which was sourced as medication cost. Total and average costs for country were calculated using sample estimates and the total number of uncomplicated malaria cases that received inappropriate prescriptions.ResultsThe study revealed that patients received an average of two prescriptions per malaria episode. Artemether-lumefantrine (AL) was the major malaria medication (79.5%) prescribed to patients. Other medications usually antibiotics and vitamins and minerals were included in the prescription. More than 50% of prescribers did not follow the guidelines for prescribing medications to clients. By facility type, inappropriate prescription was high in the CHPS compounds (59.1%) and by ownership, government (58.3%), private (57.5%) and mission facilities (50.7%). Thus, about 55% of malaria prescriptions were evaluated as inappropriate during the review period, which translates into economic cost of approximately US$4.52 million for the entire country in 2016. The total cost of inappropriate prescription within the study sample was estimated at US$1,088.42 while the average cost was US$1.20.ConclusionInappropriate prescription for malaria is a major threat to malaria management in Ghana. It presents a huge economic burden to the health system. Training and strict enforcement of prescribers’ adherence to the standard treatment guideline is highly recommended.

Time optimization in primary care – chronic prescription cost

IntroductionTime optimization is a common goal to most health information institutions. In several countries, chronic electronic renewal prescriptions were one of the main focuses when implementing information systems. In Portugal, Electronic Medical Prescription (PEM®) software is used for most electronic prescriptions. This study aims to quantify the time spent in chronic prescription renewal appointments (CPRA) in primary care and its impact in the Portuguese National Health System (SNS).MethodsEight general practitioners (GP) were included in the study during February 2022. The average duration of 100 CPRA was obtained. To determine the number of CPRA performed every year, a primary care BI-CSP® platform was used. Using Standard Cost Model and average medical doctor hourly rate in Portugal we estimated CPRA global costs.ResultsEach doctor spent on average 1:55 ± 01:07 min per CPRA. There were 8295 GP working in 2022. A total 635 561 CPRA were performed in 2020 and 774 346 in 2021. In 2020, CPRA costs ranged 303 088 ± 179 419€, and in 2021 that number increased to 369 272 ± 218 599€.ConclusionThis is the first study to quantify CPRA’s real cost in Portugal. A PEM® software update would allow daily savings, ranging from 830€ (± 491€) in 2020 and 1011€ (± 598€) in 2021. That change could allow hiring 8 ± 5 GP in 2020 and 12 ± 7 in 2021.