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
1 to 25 of 108 Research Studies DisplayedAnderson KE, DiStefano MJ, Liu A
Incorporating added therapeutic benefit and domestic reference pricing into Medicare payment for expensive part B drugs.
The objective of this retrospective analysis was to identify expensive Part B drugs and to consider the evidence for each drug's added benefit in order to model a reimbursement policy for Medicare that integrates added benefit assessment and domestic reference pricing. Data were taken from a nationally representative sample of traditional Medicare Part B claims. The analysis showed that more than one-third of the expensive Part B drugs prescribed in 2019 offered low added benefit. The authors concluded that reference pricing based on added benefit assessment could be used to address the launch prices for expensive Part B drugs with low added benefit.
AHRQ-funded; HS000029.
Citation: Anderson KE, DiStefano MJ, Liu A .
Incorporating added therapeutic benefit and domestic reference pricing into Medicare payment for expensive part B drugs.
Value Health 2023 Sep; 26(9):1381-88. doi: 10.1016/j.jval.2023.05.018..
Keywords: Medicare, Payment, Medication, Healthcare Costs
Jazowski SA, Samuel-Ryals CA, Wood WA
Association between low-income subsidies and inequities in orally administered antimyeloma therapy use.
This study’s goal was to determine the association between low-income subsidies and inequities in orally administered antimyeloma therapy use. This retrospective cohort study used Surveillance, Epidemiology, and End Results-Medicare data to identify beneficiaries diagnosed with multiple myeloma between 2007 and 2015. The authors examined therapy initiation in the 30, 60, and 90 days following diagnosis and adherence to and discontinuation of treatment in the 180 days following initiation. They found that receipt of full subsidies was not associated with earlier initiation of or improved adherence to orally administered antimyeloma therapy. Full-subsidy enrollees were 22% more likely to experience earlier treatment discontinuation than nonsubsidy enrollees. Black full-subsidy and nonsubsidy enrollees were 14% less likely than their White counterparts to ever initiate treatment.
AHRQ-funded; HS026122.
Citation: Jazowski SA, Samuel-Ryals CA, Wood WA .
Association between low-income subsidies and inequities in orally administered antimyeloma therapy use.
Am J Manag Care 2023 May; 29(5):246-54. doi: 10.37765/ajmc.2023.89357..
Keywords: Healthcare Costs, Medication, Low-Income
Bond AM, Dean EB, Desai SM
The role of financial incentives in biosimilar uptake in Medicare: Evidence from the 340b program.
This study’s goal was to investigate whether the 340B Drug Pricing Program, which offers eligible hospitals substantial discounts on drug purchases, inhibits biosimilar uptake. Almost one-third of eligible US hospitals participate in the program. The authors used regression discontinuity design and two high-volume biologics with biosimilar competitors, filgrastim and infliximab to estimate that 340B program eligibility was associated with a 22.9-percentage-point reduction in biosimilar adoption. Additionally, 340B program eligibility was associated with 13.3 more biologic administrations annually per hospital and $17,919 more biologic revenue per hospital. The effect was found to be that it inhibited biosimilar uptake, possibly because of financial incentives that make reference drugs more profitable than biosimilar medications.
AHRQ-funded; HS027531.
Citation: Bond AM, Dean EB, Desai SM .
The role of financial incentives in biosimilar uptake in Medicare: Evidence from the 340b program.
Health Aff 2023 May; 42(5):632-41. doi: 10.1377/hlthaff.2022.00812..
Keywords: Medicare, Medication, Healthcare Costs
Rao Rao, Akrobetu DJ, Dickert NW
Deciding whether to take sacubitril/valsartan: how cardiologists and patients discuss out-of-pocket costs.
The purpose of this study was to characterize patient-cardiologist discussions concerning out-of-pocket costs associated with sacubitril/valsartan during the early post-approval period. Researchers conducted a content analysis of 222 deidentified transcripts of audio-recorded outpatient encounters in which cardiologists and patients discussed whether to initiate, continue, or discontinue sacubitril/valsartan. Issues of cost occurred in nearly half the discussions, but the researchers note that cost conversations were generally superficial, rarely addressing affordability or cost-value judgments. Cardiologists frequently provided patients with free sacubitril/valsartan samples with no plan to address costs after the sample course ran out.
AHRQ-funded; HS026081.
Citation: Rao Rao, Akrobetu DJ, Dickert NW .
Deciding whether to take sacubitril/valsartan: how cardiologists and patients discuss out-of-pocket costs.
J Am Heart Assoc 2023 Apr 4; 12(7):e028278. doi: 10.1161/jaha.122.028278..
Keywords: Decision Making, Medication, Cardiovascular Conditions, Healthcare Costs
Encinosa W, Moon K, Figueroa J
AHRQ Author: Encinosa W
Complications, adverse drug events, high costs, and disparities in multisystem inflammatory syndrome in children vs COVID-19.
This cross-sectional study’s goal was to determine outcomes from multisystem inflammatory syndrome in children (MIS-C) after COVID-19. Outcomes examined were 50 complications, adverse medication events, costs, and the Social Vulnerability Index. An analysis was conducted using data from the 2021 HCUP in individuals younger than 21 years from 31 states. There were 4107 individuals hospitalized with MIS-C (median age 9 years, 59.5% male, 38.1% White) and 23,686 hospitalizations for COVID-19 without MIS-C (median age 15 years, 54.5% female, 44.1% White). Hospitalization rate for MIS-C was 1.48 per 100,000 children, ranging from 0.97 hospitalizations per 100 for White and 1.99 hospitalizations per 100 for Black children. Outcomes were worse when organ dysfunction increased from 2 to 8 organs, with deaths increasing from less than 1% to 5.8% for MIS-C, and 1% to 17.2% for COVID-19. Median length of stay increased from 4 to 8 days for MIS-C, and 3 to 16 days for COVID-19. Median costs for MIS-C increased from $16,225 to $53 359 and from $6474 to $98,643 for COVID-19. The percentage of MIS-C cases in Black children doubled from 16.2% to 31.7% as organ dysfunction increased, remaining unchanged with COVID-19.
AHRQ-authored.
Citation: Encinosa W, Moon K, Figueroa J .
Complications, adverse drug events, high costs, and disparities in multisystem inflammatory syndrome in children vs COVID-19.
JAMA Netw Open 2023 Jan;6(1):e2244975. doi: 10.1001/jamanetworkopen.2022.44975..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, COVID-19, Medication, Adverse Drug Events (ADE), Adverse Events, Healthcare Costs, Disparities, Racial and Ethnic Minorities
Toseef MU, Durfee J, Podewils LJ
Total cost of care associated with opioid use disorder treatment.
Researchers conducted a retrospective study among adult patients diagnosed with opioid use disorder (OUD) and who had a clinical encounter at a safety-net institution in Denver in 2020 to investigate the association of medication for opioid use disorder (MOUD) treatment initiation and ongoing care on overall healthcare costs of Medicaid Fee-for-Service patients. Results indicated that patients with OUD who initiated MOUD treatment but were not linked to ongoing care had the highest healthcare cost, while those who were linked to ongoing MOUD treatment had the lowest cost. The researchers concluded that MOUD treatment was not only effective at addressing the morbidity and mortality burden of OUD, but also associated with decreased financial costs. They noted that additional policy and care delivery changes will be needed to focus efforts for improve linkage to ongoing treatment
AHRQ-funded; HS027389.
Citation: Toseef MU, Durfee J, Podewils LJ .
Total cost of care associated with opioid use disorder treatment.
Prev Med 2023 Jan;166:107345. doi: 10.1016/j.ypmed.2022.107345.
Keywords: Opioids, Healthcare Costs, Substance Abuse, Behavioral Health, Medication
Sachs RE, Jazowski SA, Gavulic KA
Medicaid and accelerated approval: spending on drugs with and without proven clinical benefits.
The purpose of this article was to assess what level of Medicaid programs' accelerated approval spending is expended on products that have verified clinical benefits versus those that do not. The study found evidence of states’ concerns that pharmaceutical companies frequently do not complete the mandatory post-approval confirmatory studies within the FDA's required timeline. The study also illuminated an issue often overlooked by policy stakeholders: the utilization of surrogate endpoints involved in the post-approval confirmatory studies for most of the sample products. The researchers reported that the detailed nature of their results allowed them to evaluate the impact of different policy recommendations and to inform the current policy debate.
AHRQ-funded; HS026122.
Citation: Sachs RE, Jazowski SA, Gavulic KA .
Medicaid and accelerated approval: spending on drugs with and without proven clinical benefits.
J Health Polit Policy Law 2022 Dec 1;47(6):673-90. doi: 10.1215/03616878-10041107..
Keywords: Medicaid, Medication, Healthcare Costs
Yeung K, Bloudek L, Ding Y
AHRQ Author: Ding Y
Value-based pricing of US prescription drugs: estimated savings using reports from the Institute for Clinical and Economic Review.
The purpose of this cross-sectional study was to estimate how annual United States drug spending would change if prices for drugs were set to the Institute for Clinical and Economic Review- (ICER-) reported value-based prices (VBPs). The study included 73 unique drugs, the sum of which accounted for $110.4 billion in annual U.S. drug spending, approximately one-fifth of total U.S. drug spending in 2020. The researchers found that 11 unique drugs had multiple ICER-reported VBPs. 86.3% had observed net prices higher than the VBPs at $100,000 per quality-adjusted life-year (QALY) and and 72.6%, had $150,000 per QALY thresholds. Applying VBPs at $100,000 per QALY and $150,000 per QALY reduced the median spending per drug by $373 million. The researchers concluded that the reduction in median spending per drug reduction equated to an estimated total annual savings of $11.8 billion to $40.3 billion for the 73 drugs included in the study.
AHRQ-authored.
Citation: Yeung K, Bloudek L, Ding Y .
Value-based pricing of US prescription drugs: estimated savings using reports from the Institute for Clinical and Economic Review.
JAMA Health Forum 2022 Dec;3(12):e224631. doi: 10.1001/jamahealthforum.2022.4631..
Keywords: Healthcare Costs, Medication
Glynn A, Hernandez I, Roberts ET
Consequences of forgoing prescription drug subsidies among low-income Medicare beneficiaries with diabetes.
This study’s objective was to estimate the take-up of the Medicare Part D Low-Income Subsidy (LIS) among Medicare beneficiaries with diabetes and examine differences in out-of-pocket costs and prescription drug use between LIS enrollees and LIS-eligible non-enrollees. Data from the Health and Retirement Study linked to Medicare administrative data from 2008 to 2016 was used. The authors first estimated LIS take-up stratified by income (≤100% of the Federal Poverty Level [FPL] and >100% to ≤150% of FPL). Second, to assess the consequences of forgoing the LIS among near-poor beneficiaries (incomes >100% to ≤150% of FPL), they conducted propensity score-weighted regression analyses to compare out-of-pocket costs, prescription drug use, and cost-related medication non-adherence among LIS enrollees and LIS-eligible non-enrollees. Among Medicare beneficiaries with diabetes, 68.1% of those considered near-poor (incomes >100% to ≤150% of FPL) received the LIS, compared to 90.3% of those with incomes ≤100% of FPL. Among near-poor beneficiaries, LIS-eligible non-enrollees incurred higher annual out-of-pocket drug spending ($518], filled 7.3 fewer prescriptions for diabetes, hypertension, and hyperlipidemia drugs, and were 8.9 percentage points more likely to report skipping drugs due to cost. all compared to LIS enrollees.
AHRQ-funded; HS026727.
Citation: Glynn A, Hernandez I, Roberts ET .
Consequences of forgoing prescription drug subsidies among low-income Medicare beneficiaries with diabetes.
Health Serv Res 2022 Oct;57(5):1136-44. doi: 10.1111/1475-6773.13990..
Keywords: Medication, Diabetes, Chronic Conditions, Low-Income, Medicare, Healthcare Costs
Tisdale RL, Cusick MM, Aluri KZ
Cost-effectiveness of dapagliflozin for non-diabetic chronic kidney disease.
The purpose of this study was to determine the cost-effectiveness of adding dapagliflozin to standard management of patients with non-diabetic chronic kidney disease (CKD). Findings showed that adding dapagliflozin to standard care improved life expectancy by 2 years, increased discounted quality-adjusted life years, and reduced the total incidence of both kidney failure on kidney replacement therapy (KRT) and average years on KRT over the lifetime of the cohort. Further, dapagliflozin plus standard care was more effective than standard care alone while increasing lifetime costs.
AHRQ-funded; HS026128.
Citation: Tisdale RL, Cusick MM, Aluri KZ .
Cost-effectiveness of dapagliflozin for non-diabetic chronic kidney disease.
J Gen Intern Med 2022 Oct;37(13):3380-87. doi: 10.1007/s11606-021-07311-5..
Keywords: Kidney Disease and Health, Medication, Chronic Conditions, Healthcare Costs
Oronce CIA, Arbanas JC, Leng M
Estimated wasteful spending on aducanumab dispensing in the U.S. Medicare population: a cross-sectional analysis.
The purpose of this study was to quantify the amount of aducanumab that is discarded because of vial dose size and calculate the potential Medicare savings that could be created by changing the vial size and drug weight to make dispensing more efficient and reduce the amount of discarded drug. The researchers calculated estimates for the monthly amount of discarded drug for each study participant, and then annualized the estimates. Costs were calculated using the 300 mg vial price, which is the larger of the two vial sizes currently available, and calculations were then made for simulated vials in three combinations (100 and 170 mg; 170 and 250mg; and 80mg, 170, and 300 mg.) Costs for each combination were then calculated. The study found that assuming a 10% drug uptake, the equivalent of between 132,398 and 694,258 vials of aducanumab would be discarded costing Medicare between $115.4 million and $604.9
million each year. If the 300 mg/3.0 ml vial was reduced to 100 mg/1.0 ml, Medicare savings would range between $70.9 and $369.0 million per year. The researchers concluded that reducing aducanumab vial size could decrease wasteful spending from discarded vials by over 60%.
million each year. If the 300 mg/3.0 ml vial was reduced to 100 mg/1.0 ml, Medicare savings would range between $70.9 and $369.0 million per year. The researchers concluded that reducing aducanumab vial size could decrease wasteful spending from discarded vials by over 60%.
AHRQ-funded; HS026498.
Citation: Oronce CIA, Arbanas JC, Leng M .
Estimated wasteful spending on aducanumab dispensing in the U.S. Medicare population: a cross-sectional analysis.
J Am Geriatr Soc 2022 Sep;70(9):2714-18. doi: 10.1111/jgs.17891..
Keywords: Medicare, Healthcare Costs, Medication
Rao BR, Speight CD, Allen LA
Impact of financial considerations on willingness to take sacubitril/valsartan for heart failure.
This survey’s objective was to evaluate the impact of out-of-pocket costs and a novel cost-priming intervention on willingness to take sacubitril/valsartan for heart failure with reduced ejection fraction, as these medications carry higher out-of-pocket costs relative to angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Participants with self-reported heart disease were surveyed using the online Ipsos Knowledge Panel. Participants were presented with a modified decision aid for sacubitril/valsartan and then, in a 3×2 factorial design, randomly assigned to 1 of 3 cost conditions ($10, $50, or $100/month) and to a control group or cost-priming intervention. Cost-priming intervention is defined by being asked questions about their financial situation before learning about the benefits of sacubitril/valsartan. Of the 1013 participants included in the analysis, 85% of respondents were willing to take sacubitril/valsartan at $10, 62% at $50, and 33% at $100. In a multivariable logistic regression model, participants were more likely to take sacubitril/valsartan at $10 versus $100 and $50 compared with $100. Overall, participants in the cost-primed group were more willing to take sacubitril/valsartan than those not primed to consider their financial situation (63% versus 56%), but there was no statistically significant interaction between cost conditions and cost priming. The perceived benefit of sacubitril/valsartan over angiotensin-converting enzyme inhibitors or angiotensin receptor blockers decreased as cost increased but did not vary by cost priming.
AHRQ-funded; HS026081.
Citation: Rao BR, Speight CD, Allen LA .
Impact of financial considerations on willingness to take sacubitril/valsartan for heart failure.
J Am Heart Assoc 2022 Jun;11(12):e023789. doi: 10.1161/jaha.121.023789.
Keywords: Healthcare Costs, Medication, Heart Disease and Health, Cardiovascular Conditions
Anderson KE, Polsky D, Dy S
Prescribing of low- versus high-cost Part B drugs in Medicare Advantage and traditional Medicare.
The purpose of this study was to compare Medicare Advantage (MA) coverage with traditional Medicare (TM) coverage as it relates to whether MA is associated with greater efficiency of prescribing Part B drugs. The authors sampled 20% of all 2016 outpatient and carrier TM claims and MA encounter records and Master Beneficiary Summary File data and analyzed whether MA enrollees more often received the low-cost Part B drug compared to TM enrollees. Four clinical scenarios were evaluated where multiple, similarly effective drugs exist: (1) anti-VEGF agents to treat macular degeneration, (2) bone resorption inhibitors for osteoporosis, (3) bone resorption inhibitors for malignant neoplasms, and (4) intravenous iron for iron deficiency anemia. The researchers estimated spending differences if TM prescribing aligned with MA prescribing and evaluated whether differences between MA and TM prescribing patterns were due to differences in the hospitals and provider practices who treat MA and TM enrollees or differences in how those hospitals and provider practices engage with their MA vs TM patients. The researchers found that more MA enrollees received the low-cost drug vs. TM enrollees in all 4 clinical scenarios, and that if TM prescribing matched that of ME prescribing, there would be a spending savings of 6% to 20% for each of the 4 scenarios. The study concluded that in 4 clinical scenarios in which similarly or equally effective treatment options exist, MA enrollees were more likely than TM enrollees to receive low-cost Part B drugs.
AHRQ-funded; HS000029.
Citation: Anderson KE, Polsky D, Dy S .
Prescribing of low- versus high-cost Part B drugs in Medicare Advantage and traditional Medicare.
Health Serv Res 2022 Jun;57(3):537-47. doi: 10.1111/1475-6773.13912..
Keywords: Medication, Medicare, Healthcare Costs
Sun EC, Rishel CA, Jena AB
Association between changes in postoperative opioid utilization and long-term health care spending among surgical patients with chronic opioid utilization.
There is growing interest in identifying and developing interventions aimed at reducing the risk of increased, long-term opioid use among surgical patients. While understanding how these interventions impact health care spending has important policy implications and may facilitate the widespread adoption of these interventions, the extent to which they may impact health care spending among surgical patients who utilize opioids chronically is unknown. This study examined the association between changes in postoperative opioid utilization and long-term health care spending among surgical patients with chronic opioid utilization.
AHRQ-funded; HS026753.
Citation: Sun EC, Rishel CA, Jena AB .
Association between changes in postoperative opioid utilization and long-term health care spending among surgical patients with chronic opioid utilization.
Anesth Analg 2022 Mar;134(3):515-23. doi: 10.1213/ane.0000000000005865..
Keywords: Opioids, Medication, Healthcare Costs, Long-Term Care, Substance Abuse
Desai SM, Wang J, Ananthakrishnan UM
Estimation of potential savings associated with switching medication formulation.
The purpose of this study was to explore the price differences between different forms of prescription drugs (capsule, tablet, or ointment and cream forms) for insured patients and estimate the possible cost savings associated with changing Medicaid formulation.
AHRQ-funded; HS026980.
Citation: Desai SM, Wang J, Ananthakrishnan UM .
Estimation of potential savings associated with switching medication formulation.
JAMA Health Forum 2022 Feb 4;3(2):e214823. doi: 10.1001/jamahealthforum.2021.4823..
Keywords: Medication, Healthcare Costs
Sun D, Heimall JR, Greenhawt MJ
Cost utility of lifelong immunoglobulin replacement therapy vs hematopoietic stem cell transplant to treat agammaglobulinemia.
This study evaluated the cost utility of lifelong immunoglobulin replacement therapy (IRT) versus hematopoietic stem cell transplant (HSCT) to treat agammaglobulinemia. This economic evaluation used Markov analysis to model the base-case scenario of a patient aged 12 months to receive lifelong IRT vs matched sibling donor (MSD) or matched unrelated donor (MUD) HSCT. In this evaluation, lifelong IRT cost more than HSCT ($1,512,946 compared with $563,776 [MSD] and $637,036 [MUD]) and generated similar quality-adjusted life-years (QALYs) (20.61 vs 17.25 [MSD] and 17.18 [MUD]). While choosing IRT over HSCT generated higher incremental cost-effectiveness ratios (ICERs), it exceeded US willing-to-pay threshold of $100,000/QALY. However, IRT prevented at least 2488 premature deaths per 10,000 microsimulations compared with HSCT treatment. But when the annual IRT price was reduced from $60,145 to below $29,469, IRT became the cost-effective strategy.
AHRQ-funded; HS024599.
Citation: Sun D, Heimall JR, Greenhawt MJ .
Cost utility of lifelong immunoglobulin replacement therapy vs hematopoietic stem cell transplant to treat agammaglobulinemia.
JAMA Pediatr 2022 Feb; 176(2):176-84. doi: 10.1001/jamapediatrics.2021.4583..
Keywords: Medication, Healthcare Costs, Treatments, Evidence-Based Practice
McClellan C, Moriya A, Simon K
AHRQ Author: McClellan C Moriya A
Users of retail medications for opioid use disorders faced high out-of-pocket prescription spending in 2011-2017.
This paper provides national estimates of financial costs faced by the population receiving retail medications for opioid use disorders (MOUD). Using MEPS data, findings showed that patients with retail MOUD prescriptions spent 3.4 times more out-of-pocket for prescriptions on average than the rest of the U.S. population, with 18.8% of this population paying entirely out-of-pocket for their MOUD prescriptions. Insurance coverage was associated with reduced annual out-of-pocket MOUD expenditures. Future policies that expand insurance and address out-of-pocket spending on MOUD could increase access to medications among individuals with opioid use disorders.
AHRQ-authored.
Citation: McClellan C, Moriya A, Simon K .
Users of retail medications for opioid use disorders faced high out-of-pocket prescription spending in 2011-2017.
J Subst Abuse Treat 2022 Jan;132:108645. doi: 10.1016/j.jsat.2021.108645..
Keywords: Medical Expenditure Panel Survey (MEPS), Opioids, Substance Abuse, Behavioral Health, Healthcare Costs, Medication
Nanji KC, Shaikh SD, Jaffari A
A Monte Carlo simulation to estimate the additional cost associated with adverse medication events leading to intraoperative hypotension and/or hypertension in the United States.
This study’s objective was to estimate the rates of clinically significant intraoperative hypotension and hypertension. Systematic literature reviews were conducted to estimate incidence and additional costs of acute kidney injury (AKI), acute myocardial injury, and stroke after intraoperative hypotension and hypertension. The authors used Monte Carlo simulation to estimate annual costs to the U.S. healthcare system. Intraoperative hypotension occurred in 11 of 277 operations (3.97%), a >30% drop in baseline mean arterial pressure hypotension in patients with coronary artery disease in 9 operations (3.25%), and hypertension in 14 operations (5.05%). After hypertension, incremental stroke incidence was 4.76%. The authors estimated 11,513 cases of AKI, 5914 cases of acute myocardial injury, 345 cases of stroke after intraoperative hypotension, and 47,774 cases of stroke after intraoperative hypertension. Estimated costs were $1.7 billion, of which $923 million are preventable.
AHRQ-funded; HS024764.
Citation: Nanji KC, Shaikh SD, Jaffari A .
A Monte Carlo simulation to estimate the additional cost associated with adverse medication events leading to intraoperative hypotension and/or hypertension in the United States.
J Patient Saf 2021 Dec 1;17(8):e758-e64. doi: 10.1097/pts.0000000000000926..
Keywords: Medication, Adverse Drug Events (ADE), Adverse Events, Healthcare Costs
Duvalyan A, Pandey A, Vaduganathan M
Trends in anticoagulation prescription spending among Medicare Part D and Medicaid beneficiaries between 2014 and 2019.
Researchers examined contemporary direct oral anticoagulant (DOAC) spending patterns within Medicare Part D and Medicaid between 2014 and 2019. They found that, although overall DOAC spending is increasing, DOAC use may be associated with lower downstream medical expenditures compared with warfarin stemming from decreased risk of major bleeding and stroke and reduced drug monitoring.
AHRQ-funded; HS022418.
Citation: Duvalyan A, Pandey A, Vaduganathan M .
Trends in anticoagulation prescription spending among Medicare Part D and Medicaid beneficiaries between 2014 and 2019.
J Am Heart Assoc 2021 Dec 21;10(24):e022644. doi: 10.1161/jaha.121.022644..
Keywords: Blood Thinners, Medication, Medicare, Medicaid, Healthcare Costs
Desai SM, McWilliams JM
340B Drug Pricing Program and hospital provision of uncompensated care.
This study evaluated whether hospital entry into the 340B Drug Pricing Program is associated with changes in hospital provision of uncompensated care. The authors analyzed secondary data on 340B participation and uncompensated care provision among general acute care hospitals and critical access hospitals from 2003 to 2015. They constructed an annual, hospital-level data set on hospital 340B participation and on uncompensated care provision. They did not find evidence that hospitals increased provision of uncompensated care after entry into the 340B program differentially more than hospitals that never entered or had not yet entered the program.
AHRQ-funded; HS026980; HS024072.
Citation: Desai SM, McWilliams JM .
340B Drug Pricing Program and hospital provision of uncompensated care.
Am J Manag Care 2021 Oct;27(10):432-37. doi: 10.37765/ajmc.2021.88761..
Keywords: Hospitals, Healthcare Costs, Medication
Taber DJ, Fleming JN, Su Z
Significant hospitalization cost savings to the payer with a pharmacist-led mobile health intervention to improve medication safety in kidney transplant recipients.
This paper examined hospitalization cost savings to the payer with a pharmacist-led mobile health intervention to improve medication safety in kidney transplant recipients. This study was an economic analysis of a 12-month, parallel arm, randomized controlled trial in adult kidney recipients 6 to 36 months posttransplant (NCT03247322). All participants received usual posttransplant care, while the intervention arm received supplemental clinical pharmacist-led medication therapy monitoring and management, via a smartphone-enabled mHealth app, integrated with risk-based televisits.
AHRQ-funded; HS023754.
Citation: Taber DJ, Fleming JN, Su Z .
Significant hospitalization cost savings to the payer with a pharmacist-led mobile health intervention to improve medication safety in kidney transplant recipients.
Am J Transplant 2021 Oct;21(10):3428-35. doi: 10.1111/ajt.16737..
Keywords: Healthcare Costs, Provider: Pharmacist, Telehealth, Health Information Technology (HIT), Transplantation, Hospitalization, Medication: Safety, Medication
Abdus S
AHRQ Author: Abdus S
Financial burdens of out-of-pocket prescription drug expenditures under high-deductible health plans.
This study examines financial burdens of out-of-pocket prescription drug expenditures across different levels of deductibles, focusing on low-income adults with multiple, prevalent chronic conditions. The results of this study suggest that for low-income adults with multiple chronic conditions who are enrolled in employer-sponsored high-deductible plans, out-of-pocket prescription drug costs may still result in significant financial hardships. The key takeaway point of this paper for general internists is that for patients with chronic conditions, out-of-pocket costs of prescription drugs could be excessively burdensome if they are enrolled in high-deductible plans.
AHRQ-authored.
Citation: Abdus S .
Financial burdens of out-of-pocket prescription drug expenditures under high-deductible health plans.
J Gen Intern Med 2021 Sep;36(9):2903-05. doi: 10.1007/s11606-020-06226-x..
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Healthcare Costs, Medication
Krah NM, Jones TW, Lake J
The impact of antibiotic allergy labels on antibiotic exposure, clinical outcomes, and healthcare costs: a systematic review.
In this systematic review, the authors aimed to determine how antibiotic allergy labels influenced three domains. They found that antibiotic allergy labels have negative effects on antibiotic use and exposure, clinical outcomes, and economic outcomes in a variety of clinical settings and populations.
AHRQ-funded; HS023320.
Citation: Krah NM, Jones TW, Lake J .
The impact of antibiotic allergy labels on antibiotic exposure, clinical outcomes, and healthcare costs: a systematic review.
Infect Control Hosp Epidemiol 2021 May;42(5):530-48. doi: 10.1017/ice.2020.1229..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Healthcare Costs
Caram MEV, Oerline MK, Dusetzina S
Adherence and out-of-pocket costs among Medicare beneficiaries who are prescribed oral targeted therapies for advanced prostate cancer.
The authors investigated coping and material measures of the financial hardship of abiraterone and enzalutamide among patients with advanced prostate cancer with Medicare Part D coverage. They found substantial variations in the adherence rate and out-of-pocket payments, with sociodemographic patient and regional factors found to be associated with both aspects.
AHRQ-funded; HS025707.
Citation: Caram MEV, Oerline MK, Dusetzina S .
Adherence and out-of-pocket costs among Medicare beneficiaries who are prescribed oral targeted therapies for advanced prostate cancer.
Cancer 2020 Dec 1;126(23):5050-59. doi: 10.1002/cncr.33176..
Keywords: Patient Adherence/Compliance, Medicare, Cancer: Prostate Cancer, Cancer, Medication, Healthcare Costs
Hambley BC, Anderson KE, Shanbhag SP
Payment incentives and the use of higher-cost drugs: a retrospective cohort analysis of intravenous iron in the Medicare population.
Researchers examined prescribing patterns in the context of intravenous (IV) iron, for which multiple similarly safe and efficacious formulations exist, with wide variations in price. Using Medicare data, they found an increase in the dispensing of a higher-priced IV iron formulation associated with a shortage of a less expensive drug that persisted once the shortage ended. They concluded that their findings in IV iron have broader implications for Part B drug payment policy because the price of the drug determines the physician and health system payment.
AHRQ-funded; HS000029.
Citation: Hambley BC, Anderson KE, Shanbhag SP .
Payment incentives and the use of higher-cost drugs: a retrospective cohort analysis of intravenous iron in the Medicare population.
Am J Manag Care 2020 Dec;26(12):516-22. doi: 10.37765/ajmc.2020.88539..
Keywords: Elderly, Medication, Medicare, Payment, Healthcare Costs, Practice Patterns