US Managed Care Plan Research Articles

Observational study of the effects of using montelukast vs fluticasone in patients matched at baseline

The relative effectiveness of inhaled corticosteroids and leukotriene receptor antagonists in asthma therapy continues to be the subject of clinical studies. Recent studies have examined the impact of these therapies using a retrospective design. Retrospective studies require special attention to nonrandom assignment of participants to treatment groups and, consequently, to the need to appropriately account for baseline differences. To examine the relative effectiveness of montelukast sodium vs fluticasone propionate as controller monotherapy in patients with asthma. A retrospective cohort analysis of claims data from 6,160 individuals continuously enrolled in 1 of 20 US managed care plans. Patients using fluticasone were matched to those treated with montelukast using propensity scores and age (2-55 years). Health care use was determined for the 12-month periods before and after the initial controller prescription. Outcomes included asthma-related hospitalizations and emergency department visits, along with use of oral corticosteroids and short-acting beta-agonists. Logistic regression analyses were also performed. Overall, controller therapy significantly reduced the odds of postindex asthma-related hospitalizations (odds ratio, 0.56; 95% confidence interval, 0.38-0.79); no significant difference was observed with asthma-related emergency department visits (odds ratio, 0.89; 95% confidence interval, 0.76-1.04). Differences in the relative effect in the montelukast and fluticasone groups were not observed. Similarly, increases in the postindex rate of short-acting beta-agonist use and increases in oral corticosteroid use for both montelukast and fluticasone patients were noted. Similar outcomes were observed in montelukast and fluticasone users in this matched cohort analysis.

Direct Medical Costs Attributable to Acute Myocardial Infarction and Ischemic Stroke in Cohorts with Atherosclerotic Conditions

Background: The cost of acute ischemic events in persons with established atherosclerotic conditions is unknown. Methods: The direct medical costs attributable to secondary acute myocardial infarction (AMI) or ischemic stroke among persons with established atherosclerotic conditions were estimated from 1995–1998 data on 1,143 patients enrolled in US managed care plans. Results: The average 180-day costs attributable to secondary AMI or stroke were estimated as USD 19,056 in the AMI cohort having a private insurance (commercial; n = 344), USD 16,845 in the AMI cohort having government insurance (Medicare, age ≧65 years; n = 200), USD 10,267 for stroke commercial (n = 108), USD 16,280 for stroke Medicare (n = 113), USD 15,224 for peripheral arterial disease commercial (n = 170), and USD 15,182 for peripheral arterial disease Medicare (n = 208). Conclusion: These estimates can be used to study the cost-effectiveness of interventions proven to reduce these secondary events.

Assessing the results: Phase 1 hyperlipidemia outcomes in 27 health plans

In phase 1 of this hyperlipidemia outcomes management program, characteristics of 7,619 patients treated with statins at 27 US managed care plans were determined. Nearly 40% (3,018 patients) had documented coronary heart disease (CHD). Most (65%) had at least two CHD risk factors. Hyperlipidemia treatment included simvastatin (39%), atorvastatin (25%), fluvastatin (14%), pravastatin (12%), and lovastatin (2%). On-treatment low-density lipoprotein cholesterol (LDL-C) levels were available for 79% of patients; however, only 46% had both baseline and follow-up levels recorded in their charts. Of patients for whom follow-up data were available, 3,779 (63%) achieved their target LDL-C levels as recommended by the National Cholesterol Education Program (NCEP). Target LDL-C levels were reached by 1,381 (87%) of the patients with a goal of 160 mg/dL, 1,326 (65%) of those with a goal of 130 mg/dL, and 1,072 (44%) of those with a goal of 100 mg/dL. Overall, 66% of patients who met their treatment goal and 24% of those who did not required no more than a 25% reduction in LDL-C. In contrast, 8% of patients who achieved goals and 36% of patients who did not required >40% reduction in LDL-C. Phase 1 results did not suggest any substantial difference among statins for achievement of NCEP goals or decrease in LDL-C. These results show that therapy with statins is effective for achievement of NCEP targets in most patients and that there is potential for improvement in the quality and cost-effectiveness of statin therapy with carefully planned interventions.

Cost of care for the elderly in US managed-care plans

Cost of care for the elderly in US managed-care plans