Journal of managed care & specialty pharmacy最新文献

Background: Myelofibrosis (MF) is a rare but aggressive myeloproliferative neoplasm that commonly affects older patients, with a mean age of onset of older than 60 years. At least a third of patients with primary MF are anemic at diagnosis, and nearly all patients become anemic over time; approximately half require red blood cell transfusions within a year of diagnosis. Anemia and transfusion dependence are leading negative prognostic factors for overall survival and are associated with diminished quality of life and increased health care-related economic burden in patients with MF.

Objective: To describe baseline characteristics, health care resource utilization (HCRU), and costs as a function of transfusion status and anemia severity in patients diagnosed with MF among the US Medicare Fee-For-Service (FFS) population.

Methods: This retrospective cohort study included patients diagnosed with MF appearing in the 100% Medicare FFS database enrolled between January 1, 2012, and December 31, 2020. Patients were segmented into hemoglobin level cohorts (no, mild, moderate, and severe anemia) and transfusion status cohorts (transfusion independent [TI], transfusion requiring [TR], or transfusion dependent [TD]). Across cohorts, demographics and disease characteristics were assessed at baseline; per patient per month all-cause HCRU and medical and pharmacy costs were reported during follow-up. All results were summarized descriptively.

Results: The transfusion status cohort (N = 1,749) included TI (n = 980), TR (n = 559), and TD (n = 210) patients; the anemia severity cohort (N = 365) included patients with no (n = 100), mild (n = 128), moderate (n = 99), and severe (n = 38) anemia. On average, TR and TD patients or those with moderate or severe anemia had numerically higher Deyo-Charlson Comorbidity Index scores than those who were TI or had mild or no anemia. TR and TD cohorts reported numerically greater all-cause outpatient, inpatient, and emergency department utilization vs the TI cohort. All-cause costs were numerically higher in the TD and TR cohorts vs the TI cohort ($14,655 and $14,249 vs $8,191). Incremental increases in HCRU and costs were also observed with increasing anemia severity. All-cause medical and pharmacy costs for no, mild, moderate, and severe anemia cohorts were $4,689, $7,268, $10,439, and $13,590, respectively.

Conclusions: This retrospective analysis of the US Medicare FFS database descriptively evaluated patients by transfusion status and anemia severity and showed that costs and HCRU were numerically lower for patients with transfusion independence compared with those with transfusion dependence. Similar trends were seen when comparing patients based on anemia status, with numerically lower HCRU and cost observed with decreasing anemia severity.

Background: Rates of attainment of high-quality diabetes care have been shown to be lower for those living in more disadvantaged and rural areas. Diabetes management relies on access to care and is impacted by physical, social, and economic factors. Area deprivation index (ADI) is one way to quantify geographic disparities in aggregate. We aimed to investigate how ADI impacts outcomes in members with type 2 diabetes enrolled in a large, regional health plan.

Objective: To evalute clinical and economic objectives. Clinical objectives included the percentage of members who achieved hemoglobin A1c (A1c) goal level of 7% or less, the percentage of members who received comorbidity-focused therapies, noninsulin diabetes medication adherence, and the frequency and type of health care services used. Economic outcomes included per member per month differences in total cost of care, pharmacy cost, medical cost, and diabetes-associated cost.

Methods: This retrospective review of pharmacy and medical claims included 8,814 adult members with newly diagnosed type 2 diabetes enrolled in an integrated health plan during calendar year 2021. To be included, members were required to be at least 18 years of age, reside in Pennsylvania, and have continuous enrollment for 2 years prior to type 2 diabetes diagnosis. State-level ADI data were derived for each member and applied to the Census block group on file in the administrative claims data. The study population deciles were grouped into ADI quintiles for analysis. Multivariable regression models and descriptive statistics were used to evaluate the association between ADI and outcomes while controlling for confounding variables.

Results: There were no statistically significant differences between any ADI quintile for achievement of A1c goal or receipt of comorbidity-focused therapy. Significant differences were identified between ADI quintiles 1 (least deprived) and 5 (most deprived) for obtainment of at least 1 A1c test during calendar year 2021 (72% vs 56%, P < 0.01) and adherence to noninsulin diabetes medications (70% vs 62%, P < 0.01). Significant differences were also identified for all-cause inpatient, outpatient, and unplanned health care service utilization. The difference in per member per month all-cause total cost of care was on average $363.50 less for those living in ADI quintile 1 vs those in quintile 5 (P < 0.01).

Conclusions: Significant differences were identified between ADI quintiles 1 and 5 for noninsulin diabetes medication adherence, frequency of A1c test claims, all-cause health care service utilization, and total cost of care. There were no statistically significant differences between ADI quintiles for achievement of A1c goal or receipt of comorbidity-focused therapies.

Background: A comprehensive medication review (CMR) is an annual service offered to eligible Medicare Part D beneficiaries as a component of the Medication Therapy Management program. However, little is known about the most meaningful aspect of CMRs from the patient's perspective. This information is necessary to help improve the service.

Objective: To conduct concept elicitation interviews with patients who recently received a CMR to guide quality improvement efforts.

Methods: Those who recently received a telephonic CMR were invited to participate in semistructured interviews to provide their insights on the CMR service. An interview guide was used and contained the following 6 key questions (with additional probing questions) exploring: (1) overall experience, (2) medication knowledge, (3) concerns, (4) management, (5) satisfaction, and (6) experience. Interviews were transcribed and analyzed thematically.

Results: Interviews were conducted with 42 patients and resulted in the identification of themes related to the CMR service that were most meaningful to patients. The resulting framework contained 3 themes related to the content of the CMR (eg, medication review), the characteristics of the pharmacy professional (eg, professionalism), and the interaction during the CMR (eg, the telephonic experience). Intrinsic patient factors (eg, prior experiences) were also identified as important to contextualize patients' experiences.

Conclusions: The framework provides concrete examples of the need for continued quality improvement of the CMR service and can be illustrated using the structure-process-outcome model. Patient perspectives should be accounted for in future quality improvement activities.

Background: Available treatments for relapsed/refractory multiple myeloma (RRMM) include multiclass triplet regimens such as lenalidomide and dexamethasone (Rd backbone) plus ixazomib (proteasome inhibitor [PI]; I) or daratumumab (monoclonal antibody; D). Although prior real-world studies compared PI-Rd triplets, this research extends those findings by comparing health care costs of a PI-based and a monoclonal antibody-based triplet, IRd and DRd, in patients with RRMM in the United States.

Objective: To describe and compare all-cause and MM-related health care costs in patients with RRMM treated with IRd vs DRd.

Methods: This retrospective longitudinal study used fully adjudicated US claims data from IQVIA PharMetrics Plus (January 1, 2015, to September 30, 2020) and included adult patients who initiated IRd or DRd as second line of therapy (LOT) or later. Index date was the treatment initiation date for each LOT; baseline was 6 months pre-index. MM-related and all-cause costs per patient per month were assessed during follow-up (2020 US dollars). For MM-related costs, treatment administration costs were excluded from outpatient (OP) costs and instead summed with pharmacy costs. Costs were compared using 2-part models and generalized linear models. Inverse probability of treatment weighting was used to adjust for imbalances in baseline confounders across treatment groups.

Results: A total of 265 patients who initiated IRd or DRd were included in this analysis, contributing to 276 distinct LOTs (IRd: n = 153; DRd: n = 123). Baseline characteristics were similar between IRd and DRd cohorts after applying inverse probability of treatment weighting. Weighted (ie, adjusted) mean monthly MM-related total costs were significantly lower for the IRd cohort compared with the DRd cohort (-$8,141; P < 0.001). Total MM-related medical (-$4,764; P < 0.001), OP (-$3,152; P < 0.001), and pharmacy and OP treatment administration costs (-$3,563; P = 0.017) were also significantly lower for the IRd cohort.

Conclusions: When comparing patients with MM in the IQVIA PharMetrics Plus commercial insurance database, which reflects the payer perspective, significant cost savings were observed for patients treated with IRd vs DRd owing to lower OP and pharmacy costs. These findings may help inform real-world treatment and reimbursement decisions for patients with RRMM.

Background: Human papillomavirus (HPV) results in 37,000 new cancers each year. HPV-attributable cancers are preventable through vaccination with the completion of the HPV series encouraged by age 13 years. Public uptake has been lower than expected. Blue Cross Blue Shield of Michigan (BCBSM) implemented clinical programs to address low vaccination rates.

Objective: To compare the proportion of adolescent members who completed the HPV vaccine series before vs after implementation of clinical programs.

Methods: Retrospective, observational study of BCBSM commercial medical claims for members aged 9 to younger than 14 years. Data were divided accordingly: (A) pre-intervention (2019), (B) academic detailing (2022), and (C) academic detailing and provider incentive (2023). Years 2020 and 2021 were excluded to avoid impact from the COVID-19 pandemic. The primary outcome compared the proportion of members who completed the HPV vaccine series for Cohorts B and C compared with Cohort A. Secondary outcomes included the proportion of members who completed the first dose, the time between the dose due date and when the dose was received, average age at series completion, and dose 1 and 2 completion by month. Data were assessed using chi-square and independent t-tests.

Results: Member baseline characteristics were similar, with the majority aged 11 to younger than 13 years, male, White, and having an urban residence. For Cohorts A, B, and C, the proportion of HPV series completers were 15.3%, 15.2%, and 15.2%, respectively. The proportion of those who received only 1 dose was 15.8%, 15.6%, 15.5%, respectively. Cohorts B and C completed the series later compared with Cohort A, with the remaining time until due date as follows: 38 days (Cohort A), 8 days (Cohort B), and 4 days (Cohort C). Compared with Cohort A, Cohorts B and C had more members who received doses 1 and 2 more than 1 year apart: 8.1% (Cohort B) and 8.4% (Cohort C) compared with 6.3% (Cohort A). The average age of series completion was 12 years. August was the most popular month to receive doses 1 and 2 across all cohorts.

Conclusions: The difference observed between cohorts for the proportion of members who completed the series was not statistically significant. Cohorts B and C completed the series later compared with Cohort A, and a higher proportion received doses 1 and 2 more than 1 year apart. Although the years 2020 and 2021 were not included, lasting impact from the pandemic may have influenced study results; however, BCBSM's efforts may have mitigated the impact of the national decrease seen in HPV vaccination among in-state members.