National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
51 to 75 of 108 Research Studies DisplayedD'Agata EMC, Tran D, Bautista J
Clinical and economic benefits of antimicrobial stewardship programs in hemodialysis facilities: a decision analytic model.
In this study, the authors developed a decision analytic model of antimicrobial use on the clinical and economic consequences of implementing a nationwide antimicrobial stewardship program in outpatient dialysis facilities. The authors found that the model suggested that implementation of antimicrobial stewardship programs in outpatient dialysis facilities would result in substantial reductions in infections caused by multidrug-resistant organisms and C. difficile, infection-related deaths, and costs.
AHRQ-funded; R18 HS021666.
Citation: D'Agata EMC, Tran D, Bautista J .
Clinical and economic benefits of antimicrobial stewardship programs in hemodialysis facilities: a decision analytic model.
Clin J Am Soc Nephrol 2018 Sep 7;13(9):1389-97. doi: 10.2215/cjn.12521117..
Keywords: Antimicrobial Stewardship, Shared Decision Making, Antibiotics, Medication, Healthcare Costs, Clostridium difficile Infections, Healthcare-Associated Infections (HAIs)
Yazdany J, Dudley RA, Lin GA
Out-of-pocket costs for infliximab and its biosimilar for rheumatoid arthritis under Medicare Part D.
This paper discusses the out-of-pocket costs for infliximab and its biosimilar for rheumatoid arthritis under Medicare Part D. The investigators analyzed nationwide benefit design data for all Part D plans from the June 2017 Medicare Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files to calculate mean total cost and out-of-pocket cost requirements for infliximab-dyyb and infliximab assuming a standard 8-week dosing regimen.
AHRQ-funded; HS016772.
Citation: Yazdany J, Dudley RA, Lin GA .
Out-of-pocket costs for infliximab and its biosimilar for rheumatoid arthritis under Medicare Part D.
JAMA 2018 Sep 4;320(9):931-33. doi: 10.1001/jama.2018.7316..
Keywords: Healthcare Costs, Health Insurance, Medicare, Medication, Arthritis
Slight SP, Seger DL, Franz C
The national cost of adverse drug events resulting from inappropriate medication-related alert overrides in the United States.
Investigators worked to determine the national cost of adverse drug events (ADEs) in the United States in 2014. They used three different regression models. They used a random sample of 40,990 adult inpatients at the Brigham and Women’s Hospital in Boston with over 1.6 million medication orders. They extrapolated the medication orders using 2014 National Inpatient Sample (NIS) data. They estimated that out of 78.8 million total medication alerts, 5.5 million medication alerts would have been inappropriately overridden resulting in 196,660 ADEs. They estimated it would have cost between $871 million and $1.8 billion for treating these preventable ADEs in the United States.
AHRQ-funded; HS021094.
Citation: Slight SP, Seger DL, Franz C .
The national cost of adverse drug events resulting from inappropriate medication-related alert overrides in the United States.
J Am Med Inform Assoc 2018 Sep;25(9):1183-88. doi: 10.1093/jamia/ocy066..
Keywords: Healthcare Cost and Utilization Project (HCUP), Adverse Drug Events (ADE), Adverse Events, Clinical Decision Support (CDS), Health Information Technology (HIT), Healthcare Costs, Medical Errors, Medication
Kang H, Lobo JM, Kim S
Cost-related medication non-adherence among U.S. adults with diabetes.
The purpose of this study is to examine factors that affect cost-related medication non-adherence (CRN), defined as taking medication less than as prescribed because of cost, among adults with diabetes and to determine their relative contribution in explaining CRN. Among other results, the study found that Insulin users had 1.24 times higher risk of CRN compared to those not on insulin.
AHRQ-funded; HS018542.
Citation: Kang H, Lobo JM, Kim S .
Cost-related medication non-adherence among U.S. adults with diabetes.
Diabetes Res Clin Pract 2018 Sep;143:24-33. doi: 10.1016/j.diabres.2018.06.016..
Keywords: Diabetes, Healthcare Costs, Medication, Patient Adherence/Compliance
Shaker M, Stukus D, Chan ES
"To screen or not to screen": comparing the health and economic benefits of early peanut introduction strategies in five countries.
This study compared the costs and benefits of early peanut introduction (EPI) using data from five countries: US, Canada, Australia, New Zealand and United Kingdom. Per child it was more expensive to provide early screening for all children with early-onset eczema and/or egg allergy than to have a “wait and see” approach. While there would be more peanut allergy diagnosis with early screening, the increased costs were too great compared to the no-screening approach.
AHRQ-funded; HS024599.
Citation: Shaker M, Stukus D, Chan ES .
"To screen or not to screen": comparing the health and economic benefits of early peanut introduction strategies in five countries.
Allergy 2018 Aug;73(8):1707-14. doi: 10.1111/all.13446..
Keywords: Children/Adolescents, Screening, Diagnostic Safety and Quality, Healthcare Costs, Medication, Medication
Ngo-Metzger Q, Zuvekas SH, Bierman AS
AHRQ Author: Ngo-Metzger Q, Zuvekas SH, Bierman AS
Estimated impact of US Preventive Services Task Force Recommendations on use and cost of statins for cardiovascular disease prevention.
The purpose of the study was to assess the US population meeting criteria for statin use and factors associated with use, and calculate associated costs. The study concluded that new USPSTF recommendations may result in decreased out-of-pocket costs and expanded access to statins. Previous research has shown that eliminating copayments increased adherence and decreased rates of ASCVD events without increasing overall healthcare costs.
AHRQ-authored.
Citation: Ngo-Metzger Q, Zuvekas SH, Bierman AS .
Estimated impact of US Preventive Services Task Force Recommendations on use and cost of statins for cardiovascular disease prevention.
J Gen Intern Med 2018 Aug;33(8):1317-23. doi: 10.1007/s11606-018-4497-4..
Keywords: Cardiovascular Conditions, Healthcare Costs, Medication, Prevention, U.S. Preventive Services Task Force (USPSTF)
Murphy CC, Fullington HM, Alvarez CA
Polypharmacy and patterns of prescription medication use among cancer survivors.
The population of cancer survivors is rapidly growing in the United States. Long-term and late effects of cancer, combined with the ongoing management of other chronic conditions, make survivors particularly vulnerable to polypharmacy and its adverse effects. In the current study, the authors examined patterns of prescription medication use and polypharmacy in a population-based sample of cancer survivors.
AHRQ-funded; HS022418.
Citation: Murphy CC, Fullington HM, Alvarez CA .
Polypharmacy and patterns of prescription medication use among cancer survivors.
Cancer 2018 Jul 1;124(13):2850-57. doi: 10.1002/cncr.31389..
Keywords: Cancer, Healthcare Costs, Medical Expenditure Panel Survey (MEPS), Medication
Cole AL, Dusetzina SB
Generic price competition for specialty drugs: too little, too late?
This paper discusses potential barriers to effective generic price competition for specialty prescription drugs, including fewer market entrants, smaller-than-expected price reductions, shifts in prescribing toward more expensive brand-name treatments, and limited uptake of the generic product.
AHRQ-funded; HS000032.
Citation: Cole AL, Dusetzina SB .
Generic price competition for specialty drugs: too little, too late?
Health Aff 2018 May;37(5):738-42. doi: 10.1377/hlthaff.2017.1684..
Keywords: Healthcare Costs, Medication
Mahmoud L, Zullo AR, Thompson BB
Outcomes of protocolised analgesia and sedation in a neurocritical care unit.
Researchers conducted a retrospective cohort study of 1197 mechanically ventilated patients admitted to a 12-bed neurocritical care unit (NCCU) over four years in order to evaluate the effect of an analgesia-based sedation protocol on medication use and costs in the NCCU. The protocol resulted in increased in fentanyl use and decreased in propofol use, but their findings indicate no effect on healthcare utilization, healthcare costs, or in-hospital mortality. Based on these results, the researchers suggest that similar NCCUs should consider using population-specific protocols to manage analgesia and sedation.
AHRQ-funded; HS022998.
Citation: Mahmoud L, Zullo AR, Thompson BB .
Outcomes of protocolised analgesia and sedation in a neurocritical care unit.
Brain Inj 2018;32(7):941-47. doi: 10.1080/02699052.2018.1469167..
Keywords: Care Management, Brain Injury, Critical Care, Healthcare Costs, Intensive Care Unit (ICU), Medication, Neurological Disorders, Outcomes, Patient-Centered Outcomes Research
Karter AJ, Parker MM, Solomon MD
Effect of out-of-pocket cost on medication initiation, adherence, and persistence among patients with type 2 diabetes: the Diabetes Study of Northern California (DISTANCE).
This study estimated the effect of out-of-pocket (OOP) cost on nonadherence to classes of cardiometabolic medications among patients with diabetes. Primary nonadherence (never dispensed) increased monotonically with OOP cost after adjusting for demographics, neighborhood socioeconomic status, Medicare, medical financial assistance, OOP maximum, deductibles, mail order pharmacy incentive and use, drug type, generic or brand, day's supply, and comorbidity index.
AHRQ-funded; HS022408.
Citation: Karter AJ, Parker MM, Solomon MD .
Effect of out-of-pocket cost on medication initiation, adherence, and persistence among patients with type 2 diabetes: the Diabetes Study of Northern California (DISTANCE).
Health Serv Res 2018 Apr;53(2):1227-47. doi: 10.1111/1475-6773.12700.
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Keywords: Diabetes, Healthcare Costs, Health Insurance, Medication, Patient Adherence/Compliance
Olszewski AJ, Zullo AR, Nering CR
Use of charity financial assistance for novel oral anticancer agents.
Novel oral targeted drugs are increasingly used for cancer therapy, but their extreme cost, often exceeding $10,000 per month, poses a significant barrier for patients and insurers alike. The findings findings of this study indicate that high out-of-pocket burden for expensive novel oral anticancer drugs leads to widespread use of charity support in the United States and that a significant financial barrier disparately affects older Medicare beneficiaries.
AHRQ-funded; HS022998.
Citation: Olszewski AJ, Zullo AR, Nering CR .
Use of charity financial assistance for novel oral anticancer agents.
J Oncol Pract 2018 Apr;14(4):e221-e28. doi: 10.1200/jop.2017.027896.
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Keywords: Cancer, Elderly, Healthcare Costs, Medicare, Medication
Desai S, McWilliams JM
Consequences of the 340B drug pricing program.
Researchers used Medicare claims and a regression-discontinuity design, taking advantage of the threshold for program eligibility among general acute care hospitals to isolate the effects of the 340B Drug Pricing Program on hospital-physician consolidation and on the outpatient administration of parenteral drugs. They concluded that the Program has been associated with hospital-physician consolidation in hematology-oncology and with more hospital-based administration of parenteral drugs in hematology-oncology and ophthalmology.
AHRQ-funded; HS024072.
Citation: Desai S, McWilliams JM .
Consequences of the 340B drug pricing program.
N Engl J Med 2018 Feb 8;378(6):539-48. doi: 10.1056/NEJMsa1706475.
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Keywords: Healthcare Costs, Payment, Hospitals, Medicare, Medication
Belenky N, Pence BW, Cole SR
Associations between Medicare Part D and out-of-pocket spending, HIV viral load, adherence, and ADAP use in dual eligibles with HIV.
This study estimated the effect of Medicare part D on self-reported out-of-pocket prescription drug spending, AIDS Drug Assistance Program (ADAP) use, antiretroviral adherence, and HIV viral load (VL) suppression among dual eligibles with HIV. It concluded that part D was associated with increased out-of-pocket spending, although the increased spending did not seem to compromise antiretroviral therapy adherence or HIV VL suppression.
AHRQ-funded; HS024858; HS000032.
Citation: Belenky N, Pence BW, Cole SR .
Associations between Medicare Part D and out-of-pocket spending, HIV viral load, adherence, and ADAP use in dual eligibles with HIV.
Med Care 2018 Jan;56(1):47-53. doi: 10.1097/mlr.0000000000000843.
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Keywords: Healthcare Costs, Human Immunodeficiency Virus (HIV), Medication, Patient Adherence/Compliance
Slota C, Davis SA, Blalock SJ
Patient-physician communication on medication cost during glaucoma visits.
The aim of this secondary analysis was to describe the frequency and nature of patient-physician communication regarding medication cost during glaucoma office visits. Most participants did not discuss medication cost during their glaucoma office visit. The majority of the subjects who discussed cost had mild disease severity (51 percent), took one glaucoma medication (63 percent), and had Medicare (49 percent) as well as a form of prescription insurance (78 percent).
AHRQ-funded; HS023054.
Citation: Slota C, Davis SA, Blalock SJ .
Patient-physician communication on medication cost during glaucoma visits.
Optom Vis Sci 2017 Dec;94(12):1095-101. doi: 10.1097/opx.0000000000001139.
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Keywords: Eye Disease and Health, Healthcare Costs, Medication, Patient and Family Engagement, Clinician-Patient Communication
Kazi DS, Lu CY, Lin GA
Nationwide coverage and cost-sharing for PCSK9 inhibitors among Medicare Part D plans.
In this research letter the investigators analyzed the June 2016 Centers for Medicare and Medicaid Services Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files for all Part D plans (except special-needs plans that may have had specialized formularies) and out-of-pocket cost requirements for PCSK9is (alirocumab and evolocumab) averaged across all plans by counties and states. The authors asserted that their findings suggest a need to lower out-of pocket costs to ensure affordability of PCSK9is for Medicare beneficiaries covered by Part D.
AHRQ-funded; HS016772.
Citation: Kazi DS, Lu CY, Lin GA .
Nationwide coverage and cost-sharing for PCSK9 inhibitors among Medicare Part D plans.
JAMA Cardiol 2017 Oct;2(10):1164-66. doi: 10.1001/jamacardio.2017.3051..
Keywords: Healthcare Costs, Medicare, Medication, Policy
Zhang M, Silverberg JI, Kaffenberger BH
Prescription patterns and costs of acne/rosacea medications in Medicare patients vary by prescriber specialty.
The researchers described the medications used for treating acne/rosacea in the Medicare population and evaluated differences in costs between specialties. They concluded that costs of prescriptions for acne/rosacea from specialists are higher than those from primary care physicians and could be reduced by choosing generic and less expensive options.
AHRQ-funded; HS023011.
Citation: Zhang M, Silverberg JI, Kaffenberger BH .
Prescription patterns and costs of acne/rosacea medications in Medicare patients vary by prescriber specialty.
J Am Acad Dermatol 2017 Sep;77(3):448-55.e2. doi: 10.1016/j.jaad.2017.04.1127.
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Keywords: Medication, Skin Conditions, Healthcare Costs, Medicare, Elderly
Robinson JC, Whaley CM, Brown TT
Association of reference pricing with drug selection and spending.
This study used difference-in-differences multivariable regression methods to analyze changes in prescriptions and pricing for 1,302 drugs in 78 therapeutic classes in the United States, before and after implementation of reference pricing by an alliance of private employers. It concluded that mplementation of reference pricing was associated with a higher rate of copayment by patients than in the comparison group.
AHRQ-funded; HS22098.
Citation: Robinson JC, Whaley CM, Brown TT .
Association of reference pricing with drug selection and spending.
N Engl J Med 2017 Aug 17;377(7):658-65. doi: 10.1056/NEJMsa1700087.
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Keywords: Healthcare Costs, Medication
Chen Y, Lairson DR, Chan W
Cost-effectiveness of novel agents in medicare patients with multiple myeloma: findings from a U.S. payer's perspective.
The researchers sought to determine the cost-effectiveness (measured as cost per life-year saved) of front-line novel agent-based therapy use among a cohort of elderly patients with multiple myeloma (MM) in a real-world setting. They concluded that, given the most common treatment practices in the United States, the use of novel agent-based therapy is not cost-effective at its current level of cost and effectiveness.
AHRQ-funded; HS018956.
Citation: Chen Y, Lairson DR, Chan W .
Cost-effectiveness of novel agents in medicare patients with multiple myeloma: findings from a U.S. payer's perspective.
J Manag Care Spec Pharm 2017 Aug;23(8):831-43. doi: 10.18553/jmcp.2017.23.8.831.
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Keywords: Healthcare Costs, Cancer, Comparative Effectiveness, Healthcare Costs, Medication
Shih YT, Xu Y, Liu L
Rising prices of targeted oral anticancer medications and associated financial burden on Medicare beneficiaries.
This study examined trends in targeted oral anticancer medication (TOAM) prices and patient out-of-pocket (OOP) payments in Medicare Part D and estimated the actual effects on patient OOP payments of partial filling of the coverage gap by 2012. It concluded that rising TOAM prices threaten the financial relief patients have begun to experience under closure of the coverage gap in Medicare Part D.
AHRQ-funded; HS020263.
Citation: Shih YT, Xu Y, Liu L .
Rising prices of targeted oral anticancer medications and associated financial burden on Medicare beneficiaries.
J Clin Oncol 2017 Aug 1;35(22):2482-89. doi: 10.1200/jco.2017.72.3742.
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Keywords: Cancer, Medication, Healthcare Costs, Medicare, Elderly
Tajeu GS, Mennemeyer S, Menachemi N
Cost-effectiveness of antihypertensive medication: exploring race and sex differences using data from the REasons for Geographic and Racial Differences in Stroke Study.
The researchers compared the cost-effectiveness of antihypertensive medication treatment versus no-treatment in white and black adults. They concluded that antihypertensive medication treatment is cost-saving and increases quality-adjusted life-years (QALYs) for all groups considered in the model, particularly among black adults.
AHRQ-funded; HS013852.
Citation: Tajeu GS, Mennemeyer S, Menachemi N .
Cost-effectiveness of antihypertensive medication: exploring race and sex differences using data from the REasons for Geographic and Racial Differences in Stroke Study.
Med Care 2017 Jun;55(6):552-60. doi: 10.1097/mlr.0000000000000719.
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Keywords: Medication, Blood Pressure, Healthcare Costs, Racial and Ethnic Minorities, Stroke
Haidari LA, Brown ST, Wedlock P
When are solar refrigerators less costly than on-grid refrigerators: a simulation modeling study.
Gavi the Vaccine Alliance recommends solar refrigerators for vaccine storage in areas with less than eight hours of electricity per day, and World Health Organization guidelines are more conservative. This study investigated whether solar refrigerators provide value where electrical outages are less frequent. It identified the frequency and duration at which electrical outages need to occur for solar refrigerators to provide savings in total cost per dose administered over electric refrigerators at different solar refrigerator prices.
AHRQ-funded; HS023317.
Citation: Haidari LA, Brown ST, Wedlock P .
When are solar refrigerators less costly than on-grid refrigerators: a simulation modeling study.
Vaccine 2017 Apr 19;35(17):2224-28. doi: 10.1016/j.vaccine.2016.11.103.
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Keywords: Healthcare Costs, Medication, Vaccination
Berger BA, Cossio A, Saravia NG
Cost-effectiveness of meglumine antimoniate versus miltefosine caregiver DOT for the treatment of pediatric cutaneous leishmaniasis.
The researchers performed a cost-effectiveness analysis comparing Miltefosine administered via in-home caregiver Directly Observed Therapy (cDOT) versus injectable meglumine antimoniate (MA) for pediatric cutaneous leishmaniasis (CL) in southwest Colombia. Treatment of pediatric CL miltefosine via cDOT was found to be cost saving from patient and societal perspectives, and moderately more costly from the government payer perspective compared to treatment with MA.
AHRQ-funded; HS022433.
Citation: Berger BA, Cossio A, Saravia NG .
Cost-effectiveness of meglumine antimoniate versus miltefosine caregiver DOT for the treatment of pediatric cutaneous leishmaniasis.
PLoS Negl Trop Dis 2017 Apr 6;11(4):e0005459. doi: 10.1371/journal.pntd.0005459.
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Keywords: Patient-Centered Outcomes Research, Healthcare Costs, Medication, Healthcare Costs, Children/Adolescents
Zullo AR, Howe CJ, Galarraga O
Estimating the effect of health insurance on personal prescription drug importation.
Personal prescription drug importation occurs in the United States because of the high cost of U.S. medicines and lower cost of foreign equivalents. The investigators used inverse probability weighted marginal structural models and data on 87,494 individuals from the 2011-2013 National Health Interview Survey to estimate the marginal association between no health insurance and importation within U.S. subpopulations.
AHRQ-funded; HS022998.
Citation: Zullo AR, Howe CJ, Galarraga O .
Estimating the effect of health insurance on personal prescription drug importation.
Med Care Res Rev 2017 Apr;74(2):178-207. doi: 10.1177/1077558716629039..
Keywords: Health Insurance, Healthcare Costs, Medication
Yeung K, Basu A, Marcum ZA
Impact of a value-based formulary in three chronic disease cohorts.
This study assessed the impact of a value based formulary (VBF) on medication adherence and patient and health plan expenditures on 3 chronic disease states: diabetes, hypertension, and hyperlipidemia. The investigators measured medication expenditures from member, health plan, and member-plus-health plan (overall) perspectives and medication adherence as proportion of days covered. They conducted an exploratory analysis of medication utilization classifying medications according to whether co-payments moved up or down in the year following VBF implementation.
AHRQ-funded; HS022982.
Citation: Yeung K, Basu A, Marcum ZA .
Impact of a value-based formulary in three chronic disease cohorts.
Am J Manag Care 2017 Mar; 23(3 Suppl):S46-s53..
Keywords: Chronic Conditions, Health Insurance, Patient Adherence/Compliance, Medication, Healthcare Costs
Shen C, Zhao B, Liu L
Financial burden for patients with chronic myeloid leukemia enrolled in Medicare Part D taking targeted oral anticancer medications.
In this study, the investigators examined financial burden for patients with chronic myeloid leukemia enrolled in Medicare Part D taking targeted oral anticancer medications. The authors concluded that patients experience quick entry and exit from the coverage gap (also called the donut hole) as a result of the high price of targeted oral anticancer medications. They suggested that closing the donut hole would provide financial relief during the initial month(s) of treatment but will not completely eliminate the financial burden.
AHRQ-funded; HS020263.
Citation: Shen C, Zhao B, Liu L .
Financial burden for patients with chronic myeloid leukemia enrolled in Medicare Part D taking targeted oral anticancer medications.
J Oncol Pract 2017 Feb;13(2):e152-e62. doi: 10.1200/JOP.2016.014639..
Keywords: Cancer, Chronic Conditions, Elderly, Healthcare Costs, Medicare, Medication