US Healthcare Payers Research Articles

How Do US Health Care Payers React to and Use Pharmacoeconomic Information?

In 1997, Grabowski and Mullins described why pharmacy benefit management use of pharmacoeconomics was limited. The current manuscript examines recent changes in health care payers’ use of pharmacoeconomic information, payers’ perceptions of that information’s value for informing formulary decision making, and payers’ attitudes toward the generation and dissemination of pharmacoeconomic evidence. Despite a perceived improvement in the scientific rigor and “real-world applicability” of pharmacoeconomic information, payers remain skeptical of pharmacoeconomic evidence generated or funded by pharmaceutical manufacturers. This skepticism is reinforced when transparency is limited and when the picture provided of the comparative effectiveness of alternative products is incomplete. Payers suggest that greater two-way communications between payers and drug manufacturers could improve the usefulness of pharmacoeconomic information.

Adherence to Treatment Guidelines and Therapeutic Regimens: A US Claims-Based Benchmark of a Commercial Population

The objective of this cross-sectional, retrospective study assessing commercially insured patients was to provide a useful benchmark to US health care payers and decision makers to assess quality of care, medication use and adherence, and health care resource utilization/costs associated with common chronic diseases. Measures of quality of care were suboptimal and substantial numbers of patients were not using any pharmacotherapy considered acceptable according to treatment guidelines. The widespread nature of undertreatment, poor medication adherence, and substantial health care costs highlights deficits and points to the need for comprehensive, multifaceted strategies to improve clinical and economic outcomes for chronic diseases.

Cost Considerations in the Medical Management of Glaucoma in the US

The aim of this study was to evaluate the cost effectiveness of glaucoma treatment with bimatoprost compared with other intraocular pressure (IOP)-lowering medications in adult patients with chronic glaucoma or ocular hypertension (IOP of between 22 mm Hg and 34 mm Hg), from a US healthcare payers' perspective. Estimated yearly costs and cost per treatment success for 0.03% bimatoprost once daily (Lumigan) were compared with 0.5% timolol twice daily (generic), 0.005% latanoprost once daily (Xalatan) and the fixed combination of 0.5% timolol and 2.0% dorzolamide twice daily (Cosopt). The model was based on year 2003 medical resource costs (physician visits and drug acquisition costs) and treatment success rates from published clinical trials. The clinical measure utilised was the percentage of patients achieving target IOPs. A higher percentage of patients achieved target IOPs with bimatoprost than with each of the other medications. At most target pressures, the cost per treatment success for patients starting treatment on bimatoprost was less than that for patients started on other drugs. This was true despite that, when looking at costs alone, the estimated yearly costs for bimatoprost (averaged over both patient success and patient failures) were similar to or greater than those for the other drugs. The greatest differences in cost per treatment success were seen at target pressures < or =15 mm Hg. For example, at a target pressure of 13 mm Hg, the cost per treatment success based on the model was 9238-10,229 US dollars for bimatoprost, 23,218 US dollars for timolol, 21,943 US dollars for latanoprost and 16,034 US dollars for timolol/dorzolamide. The incremental cost of achieving additional clinical success for bimatoprost ranged from 800 US dollars to 1,700 US dollars versus generic timolol, and from 300 US dollars to 3,100 US dollars versus timolol/dorzolamide. Bimatoprost was more effective and less costly than latanoprost. In our simplified model of cost per treatment success based on responder rates at varying IOPs, the greater efficacy of bimatoprost resulted in a cost per treatment success that was generally lower for bimatoprost than for timolol, latanoprost or timolol/dorzolamide. This was most pronounced at target pressures <15 mm Hg.

Diabetic Foot Complications

Diabetic foot complications comprise foot ulceration, Charcot neuroarthropathy, and amputation. Foot complications are exceedingly common and it is estimated that more than 5% of diabetic patients will have a history of foot ulcers, whilst the cumulative lifetime risk of foot ulceration may be as high as 25%.1As up to 85% of all amputations are preceded by foot ulcers, it is safe to presume that any success in reducing foot ulcer incidence will be followed by a reduction in amputation. The economic consequences of diabetic foot lesions to the healthcare providers are vast: a recent global review2estimated that diabetic foot problems (ulcers and amputations) cost the US healthcare payers US$10.9 billion in 2001, with the equivalent figure for the UK being £252 million.This paper will therefore focus on the causation and potential for prevention of diabetic foot ulcers followed by a small note on Charcot neuroarthropathy, which is much rarer than foot ulceration.