Bailey, R

Bookhart, B

Corral, M

Lafeuille, MH

Laliberte, F

Lefebvre, P

Piech, CT

Elsevier - Publisher Connector 

DU6 ASSESSMENT OF DRUG UTILIZATION PATTERNS AND COSTS FOR ERYTHROPOIETIC STIMULATING AGENTS IN ELDERLY PATIENTS WITH CHRONIC KIDNEY DISEASE 

DU6
ASSESSMENT OF DRUG UTILIZATION PATTERNS AND COSTS
FOR ERYTHROPOIETIC STIMULATING AGENTS IN ELDERLY
PATIENTSWITH CHRONIC KIDNEY DISEASE
Lafeuille MH1, Lefebvre P1, Bookhart B2, Laliberte F1, Bailey R2,
Corral M2, Piech CT2
1Groupe d’analyse, Ltee, Montreal, QC, Canada, 2Ortho Biotech
Clinical Affairs, LLC, Bridgewater, NJ, USA
OBJECTIVE: The current study examined recent epoetin alfa
(EPO) and darbepoetin alfa (DARB) treatment patterns and cor-
responding drug costs in elderly patients with chronic kidney
disease (CKD) not receiving dialysis. METHODS: A medical
claims analysis was conducted from January 2004 through June
2007 using the Ingenix Impact National Managed Care Data-
base. Patients included in the study were 65 years, had 1
claim for CKD, and were newly initiated on EPO or DARB and
received 2 doses. Patients diagnosed with cancer or receiving
chemotherapy were excluded. Mean cumulative dose was used to
calculate drug costs, based on October 2007 wholesale acquisi-
tion unit prices (EPO $12.52/1000 Units; DARB $4.628/mcg).
RESULTS: The study population consisted of 538 patients who
received EPO and 302 patients who received DARB. The EPO
group was slightly older (EPO 74.4 years, DARB 73.5 years,
p = 0.0161) with less women (EPO: 46%; DARB: 54%,
p = 0.0241), compared to the DARB group. Mean treatment
duration was slightly longer for the EPO group (EPO 71 days,
DARB 62 days, p = 0.0516). Extended dosing frequency (deﬁned
as every 2 weeks or greater, Q2W) during treatment was
observed in the majority of patients in both groups (EPO—QW:
32%,Q2W: 68%; DARB—QW: 9%,Q2W: 91%). The mean
cumulative dose (SD) was 154,314 (155,758) Units for EPO and
558 (470) mcg for DARB, resulting in a dose ratio of 277:1
(Units EPO: mcg DARB). Based on these doses, drug cost was
25% lower for EPO than for DARB (EPO $1932; DARB $2580;
p < 0.0001). After adjusting for confounding factors, drug cost
of EPO remained signiﬁcantly lower than DARB. CONCLU-
SION: This study of CKD patients not on dialysis reported
signiﬁcantly lower drug cost in the EPO group compared to the
DARB group and a dose ratio of 277:1.
DU7
NATIONAL ESTIMATES AND DETERMINANTS OF
DEPRESSION AND ANTIDEPRESSANTTREATMENT IN
CANCER PATIENTS INTHE UNITED STATES, 2004–2005
Sankaranarayanan J, Smith LM, Meza J, Burke WJ
University of Nebraska Medical Center, Omaha, NE, USA
OBJECTIVE: Though the 2003-year National Institutes of
Health (NIH) consensus recommends study of depression and
its treatment in cancer, real-world information is limited. Our
objective was to examine national estimates and determinants
of depression and antidepressant-treatment in cancer patients to
inform providers and payers. METHODS: We conducted retro-
spective analysis of a nationally representative pooled sample of
45,557 respondents from 2004 and 2005 years of the Medical
Expenditure Panel Survey (MEPS). We extracted data on >=18
year-old adult respondents in United States (U.S.) about ICD-9-
CM-code based medical conditions (depression, cancers of the
breast, prostrate, colon, rectum, lung, and head and neck), age,
gender, race, income, health insurance, comorbidity, health-
status (physical, mental), and antidepressant-treatment (Selective
Serotonin Reuptake Inhibitor, SSRI; Tricyclic, TCA; or nonSSRI/
TCA). We weighted sample estimates of depression in cancer and
general population, and antidepressant-treatment in cancer, pro-
jected to the population, and calculated 95% conﬁdence limits
(CL) using the Taylor expansion method in SAS-callable
SUDAAN. In multivariate logistic regression, after controlling
for age, race, health insurance, poverty, health-status, and
comorbidity, we examined determinants of depression and
antidepressant-treatment in cancer patients. RESULTS: Cancer
patients were 42% more likely than the general U.S. population
to have depression (rate: 12.7% vs.9.3%, OR 1.42, 95%
CL:1.04–1.95, p = 0.024). Among cancer patients receiving an
antidepressant, the majority received an SSRI (68%) versus a
TCA (22%) or nonSSRI/TCA (23%). In multivariate analyses of
cancer patients, women were 3.3 times more likely to be diag-
nosed with depression than men (p = 0.0003), those with fair/
poor physical health-status were 2.5 times more likely to be
diagnosed with depression than those with good/excellent physi-
cal health-status (p = 0.0023), and those with depression were
24.3 times more likely to receive an antidepressant than those
without depression (p < 0.001). CONCLUSION: Increased
burden of depression in cancer patients with fair/poor physical
health-status warrants early diagnosis of depression for its
treatment.
DU8
THE EFFECT OFTHREE-TIER FORMULARY ADOPTION
FOR ALPHA-BLOCKERS ON DRUG UTILIZATION INTHE
DEPARTMENT OF DEFENSE
Devine JW, Conrad RC,Tiller KW
Department of Defense Pharmacoeconomic Center, Fort Sam
Houston,TX, USA
OBJECTIVE: We examined the effect of three-tiered formulary
implementation on drug utilization and expenditures in the
Military Health System (MHS) after a leading uroselective alpha-
blocker (tamsulosin) was restricted to non-formulary (third-tier)
status. METHODS: We evaluated 28 months of pharmacy claims
data for individuals covered under the TRICARE Pharmacy
Program, a federally funded beneﬁt available to all eligible Uni-
formed Services members, their families, and retirees. The study
patients (N = 266,380) were men, 45 years of age or older, with
at least one prescription for an alpha-blocker (AB) dispensed
between October 2004 and February 2007. The new policy
limited the availability of tamsulosin at military treatment facili-
ties, increased patient cost-sharing obligations for tamsulosin in
the TRICARE Retail Network and Mail Order pharmacy, and
designated alfuzosin as the preferred uroselective alpha-blocker
in the MHS during 12 months (months 17 through 28) of the
study. We used segmented regression models to estimate the effect
of the new policy on the use of ABs in the Military Health System
with respect to drug utilization and drug expenditures.
RESULTS: We observed an abrupt decline (29%) in the use of the
third-tier AB following the decision (p < 0.001). Concurrently,
use of the preferred uroselective product increased three-fold and
continued to grow at a faster monthly rate than predicted from
pre-implementation data (p < 0.001). Overall, the utilization of
uroselective ABs decreased slightly (11%) in the month following
the decision (p < 0.001) but then returned to baseline levels
during the post-policy period. The policy reduced drug expendi-
tures for ABs by an estimated $5.6 million during its ﬁrst 12
months. CONCLUSION: Implementation of a three-tiered for-
mulary system for alpha-blockers in the Department of Defense
led to a reduction in drug expenditures through increased utili-
zation of preferred products and higher cost-sharing obligations
for non-formulary drugs.
Abstracts A23


file:///data/remote/core/dit/data/elsevier/pdf/d02/aHR0cDovL2FwaS5lbHNldmllci5jb20vY29udGVudC9hcnRpY2xlL3BpaS9zMTA5ODMwMTUxMDcwMDg1MQ==.pdf

DU6 ASSESSMENT OF DRUG UTILIZATION PATTERNS AND COSTS FOR ERYTHROPOIETIC STIMULATING AGENTS IN ELDERLY PATIENTS WITH CHRONIC KIDNEY DISEASE

Abstract

Similar works

Full text

Available Versions

Elsevier - Publisher Connector

Elsevier - Publisher Connector