American Health and Drug Benefits最新文献

Background: Prescription drug misuse is an escalating public health problem that is prevalent among college students. Various factors, such as sex, age, race, mental health conditions, and fraternity and sorority membership, increase the risk for prescription drug misuse. Peer influences may also pose significant risks for starting prescription drug misuse, because peers are the primary source of misused prescription drugs among college students.

Objectives: To examine college students' beliefs about prescription drug misuse among their peers and to understand their beliefs about the available and potential intervention efforts to reduce prescription drug misuse.

Method: We conducted a cross-sectional survey of 312 college students aged 18 to 30 years who were enrolled in a large midwestern US university. The survey included questions about the responders' demographic characteristics, beliefs, and perceptions regarding prescription drug misuse among their peers and potential reduction programs for prescription drug misuse.

Results: The respondents' mean age was 21 years, and most (65%) respondents were women. A majority (90%) of the respondents were enrolled in the university as full-time students. More than 60% of the respondents reported knowing someone with prescription drug misuse in the past 12 months. Fraternity or sorority members were more likely to report peer prescription drug misuse than nonmembers (83% vs 60%, respectively; P = .017). Stimulants were the most misused drug class, accounting for 75% of all reported peer prescription drug misuse. Approximately 60% of the misused prescription drugs were sourced from peers, which included friends, roommates, and classmates. A total of 73% of respondents said that prescription drug misuse was a problem among college students and 67% agreed that interventions were needed to reduce prescription drug misuse. The perceived need for interventions varied by peer prescription drug misuse. A total of 90% of students whose peers did not misuse prescription drugs said that interventions were needed, but only 67% of those with peer prescription drug misuse thought that interventions were needed.

Conclusion: Our findings indicate that peer prescription drug misuse is very common among college students, and the most misused drug class is stimulants. Survey respondents perceived that the current interventions used to address prescription drug misuse are not very effective or may not be targeting the right population. Peer prescription drug misuse influences college students' perceptions about the risks and harms of prescription drug misuse, as well as the need for interventions.

Background: The use of a novel strategy known as adaptive abiraterone therapy based on mathematical modeling of evolutionary dynamics of tumor subpopulations was shown in a clinical trial to extend the time to disease progression in patients with metastatic castration-resistant prostate cancer (CRPC) and reduced the use of abiraterone therapy. Although the clinical impact of adaptive abiraterone treatment is clear, the economic impact of this strategy has not been investigated.

Objective: To compare the cost of care with adaptive abiraterone therapy versus standard continuous abiraterone therapy in patients with metastatic CRPC, using patient billing data.

Methods: We performed a retrospective review of billing data for patients with metastatic CRPC who received abiraterone treatment at a large cancer center between June 1, 2012, and August 31, 2018. Patients were divided into 2 groups based on whether they received adaptive abiraterone therapy (N = 15) or continuous abiraterone therapy (N = 21). All patients with refractory, metastatic prostate cancer after castration that was indicated for abiraterone therapy were eligible for this study. Each patient in the adaptive abiraterone therapy cohort received abiraterone plus prednisone treatment until the patient reached a target threshold of 50% or more reduction in prostate-specific antigen (PSA) level compared with his PSA level before abiraterone therapy; treatment was then suspended until the PSA level rose above the 50% of PSA before abiraterone therapy target threshold. The continuous therapy cohort received abiraterone plus prednisone daily until radiographic progression. The primary outcomes were the mean annual cost of care per patient, including and excluding the cost of abiraterone, and the cost of care, by clinical category.

Results: The median time to disease progression was 25.8 months for patients who received adaptive abiraterone therapy compared with 12.1 months for patients who received continuous abiraterone therapy. Overall, the mean total, including the cost of drug, annual cost per patient who received adaptive abiraterone therapy was $79,093 compared with $146,782 for patients who received continuous abiraterone therapy (P <.0001). The annual cost of care per patient, excluding the cost of abiraterone, was $13,883 for those who received adaptive therapy versus $22,322 for those who received continuous abiraterone therapy (P = .2757), which was not statistically significant.

Conclusion: Practical precision medicine strategies, such as adaptive abiraterone treatment or pharmacogenomics-targeted dosing, can use known biomarkers, such as PSA, to tailor therapy, generate improved outcomes, and reduce costs without the need for novel drug and diagnostic discovery and development. The results of this study suggest that a large clinical study of adaptive abirat

Background: The purchase of prescription medications via the Internet is a global phenomenon with significant economic, social, and health-related impacts. The growth of online purchasing of prescription medicines is significant and has been amplified by social isolation related to the COVID-19 pandemic, with many patients unable to obtain medicines as they normally would. By contrast, there are licensed, certified, legitimate retail pharmacies that provide significant and vital services to patients.

Objective: To review the major public health threat from illegal entities that sell any type of prescription medicines to individuals without proper physician oversight.

Discussion: Rogue and inappropriate online vendors are providing counterfeit and substandard medications fraudulently with untold impacts on morbidity and mortality globally. This article presents the differentiation between the types of legal and illegal Internet pharmacies, as well as the actions that are currently in play to affect the illegal online purchase of prescription medicines. Much must be done in a collaborative, global effort to address the public health threat of obtaining prescription drugs via the Internet.

Conclusion: Global, federal, state, health professional, societal, and patient-specific collaborations are necessary to affect the significant threat that is now present via the increasing ease of access to online medication purchases.

This section provides a brief overview of new cancer drugs approved by the FDA between July 24, 2020, and September 4, 2020.

Background: Chimeric antigen receptor (CAR) T-cell therapy, which is approved for the treatment of relapsed or refractory diffuse large B-cell lymphoma (DLBCL), can be associated with potentially severe and costly neurologic adverse events (AEs).

Objectives: To develop an evidence-based list of treatment-related neurologic AEs in patients with relapsed or refractory DLBCL, including AEs related to CAR T-cell therapies, and to estimate the healthcare costs associated with these neurologic AEs in a real-world setting.

Methods: We identified grade ≥3 neurologic AEs that occurred in ≥2% of patients by reviewing drug prescribing information and published clinical trials with therapies used for relapsed or refractory DLBCL. Data from 3 nationally representative claims databases were used to identify adults with relapsed or refractory DLBCL, who were eligible for the study if they received 1 of 4 types of therapy, including CAR T-cell therapy, high-intensity cytotoxic therapy, low-intensity cytotoxic therapy, or targeted therapies. The rates of neurologic AEs and total healthcare costs were calculated for patients with and without neurologic AEs within 30 days of treatment. The costs were inflated to 2019 first-quarter US dollars.

Results: A total of 16 types of neurologic AEs were identified, including 13 events related to CAR T-cell therapy and 5 related to conventional immunochemotherapy regimens, with 2 overlapping event types. Of these AEs, 11 were included in the claims analysis, based on available diagnosis codes. Of the 11,098 adults with relapsed or refractory DLBCL in the study, 118 patients received CAR T-cell therapy, 9483 received a high-intensity cytotoxic therapy, 1259 received a low-intensity cytotoxic therapy, and 238 received a targeted therapy. A total of 299 (2.7%) patients had ≥1 neurologic AEs during the 30-day postindex period. Of these patients, 43 received CAR T-cell therapy (36.4% of the 118 CAR T-cell therapy users). The mean total healthcare cost was $71,982 higher for patients with neurologic AEs than for patients without neurologic AEs. The trend of higher costs in patients with neurologic AEs was consistent across the treatment groups and was most pronounced in CAR T-cell therapy users ($143,309; 95% confidence interval, $5838-$280,779).

Conclusion: Patients with relapsed or refractory DLBCL who had severe or life-threatening neurologic AEs incur substantially higher costs than their counterparts who do not have neurologic AEs, with the largest cost difference in patients who receive CAR T-cell therapy.

Background: Patients with chronic coronary artery disease (CAD) and/or peripheral artery disease (PAD) have increased risks for cardiovascular (CV)-related morbidity and mortality. In the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) clinical trial of such patients, rivaroxaban plus aspirin demonstrated a significant reduction in major adverse CV events (MACE), a composite of stroke, myocardial infarction, and CV death, and major adverse limb events (MALE), a composite of chronic and acute limb ischemia, and major amputation resulting from vascular events, versus aspirin alone.

Objective: To estimate the 1-year economic implications of preventing MACE and MALE with the use of rivaroxaban plus aspirin versus aspirin alone among patients with chronic CAD and/or PAD in a US commercial health plan.

Method: A cost-consequence model was developed to evaluate the economic impact of rivaroxaban plus aspirin in a hypothetical 1-million-member health plan. The model inputs were taken from the COMPASS study (ie, the efficacy and safety of rivaroxaban plus aspirin vs aspirin), Optum Integrated Database (ie, the prevalence of chronic CAD and/or PAD, incidence rates, and healthcare costs of MACE, MALE, and major bleeding), and the RED BOOK (ie, wholesale drug acquisition costs). The cost inputs were in 2019 US dollars. One-way sensitivity analyses and subgroup analyses were conducted.

Results: A 1-year treatment with rivaroxaban plus aspirin resulted in reductions of MACE and MALE, which balance the increased risk for bleeding versus aspirin alone and indicate a net health benefit for this drug regimen. These reductions were achieved at an incremental per-member per-month (PMPM) cost of $0.16, mainly because of rivaroxaban's acquisition cost. In patients with ≥2 MACE or MALE risk factors, the incremental PMPM cost was $0.09, given the increased offset in rivaroxaban's acquisition cost by reduced rates of MACE or MALE.

Conclusions: In an era of emerging thrombocardiology, treatment with rivaroxaban plus aspirin offers an effective thrombotic risk management strategy for healthcare stakeholders in the management of chronic CAD and/or PAD. The contribution of rivaroxaban would be greater in patients with ≥2 risk factors for MACE or MALE.

Background: Botulinum neurotoxin type A (BoNT-A) is an effective treatment for many chronic conditions, but the economic implications of repeated treatments can be a burden on patients. The 3 commercial preparations of BoNT-A types available today are onabotulinumtoxinA, abobotulinumtoxinA, and incobotulinumtoxinA, but no clear differences have been found in clinical efficacy between these 3 type A toxins in blinded comparative studies.

Objective: To conduct a cost-minimization analysis in a cohort of patients with chronic neurologic conditions who switched treatment from onabotulinumtoxinA to incobotulinumtoxinA.

Methods: The study was a single-center, retrospective review of data from a large, private, neurological practice in Spokane, WA. A comprehensive patient chart review was conducted of all patients who were switched from established onabotulinumtoxinA therapy to incobotulinumtoxinA therapy between 2012 and 2019. The patients were switched at a 1:1-unit ratio. All patients had commercial insurance or Medicare coverage. Dosage, injection intervals, wastage, treatment costs, switchback data, and patient savings program eligibility were evaluated for the period of 1 year before and 1 year after the switch from onabotulinumtoxinA to incobotulinumtoxinA therapy.

Results: The most frequently treated indication was cervical dystonia (N = 61; 54.5%), followed by chronic migraine (N = 36; 32.1%). After switching to incobotulinumtoxinA therapy, botulinum toxin wastage was reduced by 87.3% (from 150.9 units to 19.1 units), and the cost was reduced by 32.2% (from $5108 to $3461) per patient annually. A total of 14,635 units in unavoidable wastage and $182,792 in annual botulinum toxin costs were saved as a result of the switch in therapy. Patients remained at consistent dosing intervals after switching to incobotulinumtoxinA therapy. A total of 8 patients switched back to onabotulinumtoxinA treatment during this review, including 3 patients who switched back because of insurance reasons, and 5 who had self-reported efficacy concerns. The 70 commercially insured patients in the study who were eligible for the patient savings program for each of the 2 therapies saved an average of $2076 (241.5%) in annual costs after switching from onabotulinumtoxinA to incobotulinumtoxinA.

Conclusion: Our findings showed that switching from onabotulinumtoxinA to incobotulinumtoxinA at similar intervals and dosages achieved considerable cost-savings, with a low incidence of switching back.