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Reise R, Ndai AM, Dewar MA, Schentrup AM, Yang J, Vouri SM. Assessment of the utilization of real-time prescription benefits for patient cost savings within an outpatient setting. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 14:100460. [PMID: 38974055 PMCID: PMC11227025 DOI: 10.1016/j.rcsop.2024.100460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 07/09/2024] Open
Abstract
Background This study evaluates the impact of Real-Time Prescription Benefits (RTPB), a tool integrated into electronic health records (EHRs), on patient out-of-pocket costs in an academic institution. RTPB provides prescribers with alternative, less expensive medications based on insurance plans. The primary measure was cost-savings, defined as the difference between the out-of-pocket cost of the prescribed medication and its alternative. Methods A retrospective analysis of prescriptions from outpatient clinics in a university-based health system was conducted between May 2020 and July 2021. Prescriptions were analyzed at the 2nd level of the Anatomical Therapeutic Chemical (ATC) classification system. Costs were standardized to a 30-day supply. Standardized cost and total cost per prescription, and overall savings for the top 20 medication classes at the 2nd ATC level were calculated. The overall impact of RTPB was estimated based on selecting the least expensive alternative suggested by RTPB. Results The study found that RTPB information was provided for 22% of prescriptions, with suggested alternatives for 1.26%. Among prescriptions with an alternative selected, the standardized average cost saving was $38.83. The study realized $15,416 in patient total cost savings. If the least expensive RTPB-suggested alternative were chosen for all prescriptions, an estimated $276,386 could have been saved. Psychoanaleptic and psycholeptic medications were the most prescribed with an alternative, with most savings in specialty drugs like anthelmintic and immunostimulant medications. Conclusion The study highlights the importance of RTPB in reducing patient costs. It reports patient cost-savings with RTPB in prescribing decisions. Future research could explore the impact of RTPB on medication adherence using pharmacy claims data.
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Affiliation(s)
- Rachel Reise
- University of Florida College of Pharmacy, Gainesville, FL, USA
- University of Florida Health Physicians, Gainesville, FL, USA
| | - Asinamai M Ndai
- University of Florida College of Pharmacy, Gainesville, FL, USA
- University of Florida Health Physicians, Gainesville, FL, USA
| | - Marvin A Dewar
- University of Florida Health Physicians, Gainesville, FL, USA
- University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Julia Yang
- University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Scott Martin Vouri
- University of Florida College of Pharmacy, Gainesville, FL, USA
- University of Florida Health Physicians, Gainesville, FL, USA
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Yu-Ting Y, Yong-Wei Y, Miao Y, Qiong Y, Meng-Yu W, Ting L. Knowledge, attitude, behaviour, and influencing factors of home-based medication safety among community-dwelling older adults with chronic diseases: a cross-sectional study. BMC Geriatr 2023; 23:256. [PMID: 37118686 PMCID: PMC10148421 DOI: 10.1186/s12877-023-03966-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/12/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Older adults with chronic diseases require long-term medication. However, due to lack of drug knowledge and hypomnesia, older adults with chronic diseases are prone to adverse drug events and increased medical costs. This study aimed to explore the status and influencing factors of home-based medication safety among community-dwelling older adults with chronic diseases in China to provide a basis for follow-up to conduct targeted health education. METHODS Overall, 427 community-dwelling older adults with chronic diseases participated in this study. The Knowledge, Attitude, and Behaviour of Medication Safety among Older Adults with Chronic Diseases Questionnaire was used to assess their home-based medication safety. Multivariate linear regression was used to identify the factors influencing knowledge, attitude, and behaviour regarding medication safety. RESULTS The average score of home-based medication safety among older adults with chronic diseases was 68.26 ± 8.96, indicating that they had a moderate grasp of medication safety. The scoring rate of each subscale was ranked from high to low as follows: behaviour (84.51%), knowledge (63.33%), and attitude (47.39%). Stepwise linear regression analysis showed that medication safety knowledge, attitudes, and behaviours were significantly associated with higher monthly income, adverse drug events, and taking medicine several times a day (p < 0.05). Additional influencing factors included having fewer chronic diseases, being female, higher educational attainment, taking medicines multiple kinds a day, better self-care ability, and non-hospitalisation for chronic illnesses (p < 0.05). CONCLUSION Medical staff and community workers should pay attention to the drug safety of older adults with different characteristics and mobilise their enthusiasm for participation to improve their medication self-management ability. TRIAL REGISTRATION Chinese Clinical Trial Register: ChiCTR2200060987 ; reg. date: 15/06/2022.
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Affiliation(s)
- Yang Yu-Ting
- Nursing Department, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Yang Yong-Wei
- The School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Yao Miao
- The School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Ye Qiong
- The School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
- Ningde Municipal Hospital of Ningde Normal University, Ningde, Fujian, China
| | - Wu Meng-Yu
- Community Health Service Center of Ninghua Street, Taijiang District, Fuzhou, Fujian, China
| | - Lin Ting
- The School of Nursing, Fujian Medical University, Fuzhou, Fujian, China.
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Gnugesser E, Chwila C, Brenner S, Deckert A, Dambach P, Steinert JI, Bärnighausen T, Horstick O, Antia K, Louis VR. The economic burden of treating uncomplicated hypertension in Sub-Saharan Africa: a systematic literature review. BMC Public Health 2022; 22:1507. [PMID: 35941626 PMCID: PMC9358363 DOI: 10.1186/s12889-022-13877-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background and Objectives Hypertension is one of the leading cardiovascular risk factors with high numbers of undiagnosed and untreated patients in Sub Saharan Africa (SSA). The health systems and affected people are often overwhelmed by the social and economic burden that comes with the disease. However, the research on the economic burden and consequences of hypertension treatment remains scare in SSA. The objective of our review was to compare different hypertension treatment costs across the continent and identify major cost drivers. Material and Methods Systematic literature searches were conducted in multiple databases (e.g., PubMed, Web of Science, Google Scholar) for peer reviewed articles written in English language with a publication date from inception to Jan. 2022. We included studies assessing direct and indirect costs of hypertension therapy in SSA from a provider or user perspective. The search and a quality assessment were independently executed by two researchers. All results were converted to 2021 US Dollar. Results Of 3999 results identified in the initial search, 33 were selected for data extraction. Costs differed between countries, costing perspectives and cost categories. Only 25% of the SSA countries were mentioned in the studies, with Nigeria dominating the research with a share of 27% of the studies. We identified 15 results each from a user or provider perspective. Medication costs were accountable for the most part of the expenditures with a range from 1.70$ to 97.06$ from a patient perspective and 0.09$ to 193.55$ from a provider perspective per patient per month. Major cost drivers were multidrug treatment, inpatient or hospital care and having a comorbidity like diabetes. Conclusion Hypertension poses a significant economic burden for patients and governments in SSA. Interpreting and comparing the results from different countries and studies is difficult as there are different financing methods and cost items are defined in different ways. However, our results identify medication costs as one of the biggest cost contributors. When fighting the economic burden in SSA, reducing medication costs in form of subsidies or special interventions needs to be considered. Trial registration Registration: PROSPERO, ID CRD42020220957. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13877-4.
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Affiliation(s)
- E Gnugesser
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany
| | - C Chwila
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany
| | - S Brenner
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany
| | - A Deckert
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany
| | - P Dambach
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany
| | - J I Steinert
- TUM School of Social Sciences and Technology, Technical University of Munich, Munich, Germany
| | - T Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany
| | - O Horstick
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany
| | - K Antia
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany
| | - V R Louis
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany.
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Association Between Cost-Saving Prescription Policy Changes and Adherence to Chronic Disease Medications: an Observational Study. J Gen Intern Med 2022; 37:531-538. [PMID: 34331213 PMCID: PMC8858373 DOI: 10.1007/s11606-021-07031-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 07/09/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Pharmacy benefit design is one tool for improving access and adherence to medications for the management of chronic disease. OBJECTIVE We assessed the effects of pharmacy benefit design programs, including a change in pharmacy benefit manager (PBM), institution of a prescription out-of-pocket maximum, and a mandated switch to 90 days' medication supply, on adherence to chronic disease medications over time. DESIGN We used a difference-in-differences design to assess changes in adherence to chronic disease medications after the transition to new prescription policies. SUBJECTS We utilized claims data from adults aged 18-64, on ≥ 1 medication for chronic disease, whose insurer instituted the prescription policies (intervention group) and a propensity score-matched comparison group from the same region. MAIN MEASURES The outcome of interest was adherence to chronic disease medications measured by proportion of days covered (PDC) using pharmacy claims. KEY RESULTS There were 13,798 individuals in each group after propensity score matching. Compared to the matched control group, adherence in the intervention group decreased in the first quarter of 2015 and then increased back to pre-intervention trends. Specifically, the change in adherence compared to the last quarter of 2014 in the intervention group versus controls was - 3.6 percentage points (pp) in 2015 Q1 (p < 0.001), 0.65 pp in Q2 (p = 0.024), 1.1 pp in Q3 (p < 0.001), and 1.4 pp in Q4 (p < 0.001). CONCLUSIONS In this cohort of commercially insured adults on medications for chronic disease, a change in PBM accompanied by a prescription out-of-pocket maximum and change to 90 days' supply was associated with short-term disruptions in adherence followed by return to pre-intervention trends. A small improvement in adherence over the year of follow-up may not be clinically significant. These findings have important implications for employers, insurers, or health systems wishing to utilize pharmacy benefit design to improve management of chronic disease.
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Londoño Agudelo E, García Fariñas A, Pérez Ospina V, Taborda Pérez C, Villacrés Landeta T, Battaglioli T, Gómez Arias R, Van der Stuyft P. Out-of-pocket expenditure for hypertension care: a population-based study in low-income urban Medellin, Colombia. Glob Health Action 2021; 13:1806527. [PMID: 32867605 PMCID: PMC7480425 DOI: 10.1080/16549716.2020.1806527] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Hypertension requires life-long medical care, which may cause economic burden and even lead to catastrophic health expenditure. Objective To estimate the extent of out-of-pocket expenditure for hypertension care at a population level and its impact on households’ budgets in a low-income urban setting in Colombia. Methods We conducted a cross-sectional survey in Santa Cruz, a commune in the city of Medellin. In 410 randomly selected households with a hypertensive adult, we estimated annual basic household expenditure and hypertension-attributable out-of-pocket expenditure. For socioeconomic stratification, we categorised households according to basic expenditure quintiles. Catastrophic hypertension-attributable expenditure was defined as out-of-pocket expenditure above 10% of total household expenditure. Results The average annual basic household expenditure was US dollars at purchasing power parity (USD-PPP) $12,255.59. The average annual hypertension-attributable out-of-pocket expenditure was USD-PPP $147.75 (95% CI 120.93–174.52). It was incurred by 73.9% (95% CI 69.4%-78.1%) of patients, and consisted mainly of direct non-medical expenses (76.7%), predominantly for dietary requirements prescribed as non-pharmacological treatment and for transport to attend health care consultations. Medical out-of-pocket expenditure (23.3%) was for the most part incurred for pharmacological treatment. Hypertension-attributable out-of-pocket expenditure represented on average 1.6% (95% CI 1.3%-1.9%) of the total annual basic household expenditure. Eight households (2.0%; 95% CI 1.0%-3.8%) had catastrophic health expenditure; six of them belonged to the two lowest expenditure quintiles. Payments related to dietary requirements and transport to consultations were critical determinants of their catastrophic expenditure. Conclusions Out-of-pocket expenditure for hypertension care is moderate on average, but frequent, and mainly made up of direct non-medical expenses. Catastrophic health expenditure is uncommon and affects primarily households in the bottom socioeconomic quintiles. Financial protection should be strengthened by covering the costs of chronic diseases-related dietary requirements and transport to health services in the most deprived households. Abbreviations NCDs: Non-communicable diseases; LMICs: Low and middle-income countries; WHO: World Health Organization; HTN: hypertension; CVDs: Cardiovascular diseases; OOPE: out-of-pocket expenditure; USD-PPP: US dollars at purchasing power parity; CI: Confidence interval
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Affiliation(s)
- Esteban Londoño Agudelo
- Department of Public Health, Institute of Tropical Medicine , Antwerp, Belgium.,Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University , Ghent, Belgium.,Facultad de Medicina, Universidad CES , Medellin, Colombia.,Facultad Nacional de Salud Pública, Grupo de Epidemiología, Universidad de Antioquia , Medellín, Colombia
| | - Anaí García Fariñas
- Dirección de Investigación Clínica y Evaluación de Impacto, Instituto Finlay de Vacunas , La Habana, Cuba
| | | | | | | | - Tullia Battaglioli
- Department of Public Health, Institute of Tropical Medicine , Antwerp, Belgium
| | - Rubén Gómez Arias
- Facultad de Medicina, Universidad CES , Medellin, Colombia.,Facultad Nacional de Salud Pública, Grupo de Epidemiología, Universidad de Antioquia , Medellín, Colombia
| | - Patrick Van der Stuyft
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University , Ghent, Belgium
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Wierzejska E, Giernaś B, Lipiak A, Karasiewicz M, Cofta M, Staszewski R. A global perspective on the costs of hypertension: a systematic review. Arch Med Sci 2020; 16:1078-1091. [PMID: 32863997 PMCID: PMC7444692 DOI: 10.5114/aoms.2020.92689] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/09/2019] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Hypertension, particularly untreated, leads to serious complications and contributes to high costs incurred by the whole society. The aim of the review was to carry out a social and economic comparison of various categories of hypertension costs from different countries. MATERIAL AND METHODS The study was a systematic review. PubMed, Cochrane Library and Google Scholar databases were searched. Hypertension costs were analyzed in 8 cost categories. An attempt was made to determine whether selected economic and social factors (such as HDI or GDP) influenced hypertension costs. RESULTS The review included data from 15 countries: Brazil, Cambodia, Canada, China, Greece, Indonesia, Italy, Jamaica, Kyrgyzstan, Mexico, Poland, Spain, USA, Vietnam and Zimbabwe. The papers included in the review were heterogeneous with respect to cost categories, which made comparisons difficult. The average total costs of hypertension for all the studied countries, calculated per person, amounted to 630.14 Int$, direct costs - 1,497.36 Int$, and indirect costs - 282.34 Int$. The ranking of countries by costs and by selected economic and social indices points at the possible relationship between these indices and hypertension costs. CONCLUSIONS The costs of hypertension calculated per country reached the region of several dozen billion Int$. Other sources usually showed lower costs than those presented in this review. This indicates a growth in costs from year to year and the future increasing burden on society. Globally uniform cost terminology and cost calculation standards need to be developed. That would facilitate making more informed decisions regarding fund allocation in hypertension management schemes.
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Affiliation(s)
- Ewelina Wierzejska
- Department of Preventive Medicine, Laboratory of International Health, Poznan University of Medical Sciences, Poznan, Poland
| | - Bogusz Giernaś
- Department of Preventive Medicine, Laboratory of International Health, Poznan University of Medical Sciences, Poznan, Poland
| | - Agnieszka Lipiak
- Department of Preventive Medicine, Laboratory of International Health, Poznan University of Medical Sciences, Poznan, Poland
| | - Monika Karasiewicz
- Department of Preventive Medicine, Laboratory of International Health, Poznan University of Medical Sciences, Poznan, Poland
| | - Mateusz Cofta
- Department of Preventive Medicine, Laboratory of International Health, Poznan University of Medical Sciences, Poznan, Poland
| | - Rafał Staszewski
- Department of Hypertensiology, Angiology and Internal Medicine, Laboratory of Pharmacoeconomics in Hypertension, Poznan University of Medical Sciences, Poznan, Poland
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Gorfinkel I, Lexchin J. We need to mandate drug cost transparency on electronic medical records. CMAJ 2018; 189:E1541-E1542. [PMID: 29255097 DOI: 10.1503/cmaj.171070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Iris Gorfinkel
- PrimeHealth Clinical Research - Family Practice (Gorfinkel); School of Health Policy and Management (Lexchin), Faculty of Health, York University, Toronto, Ont.
| | - Joel Lexchin
- PrimeHealth Clinical Research - Family Practice (Gorfinkel); School of Health Policy and Management (Lexchin), Faculty of Health, York University, Toronto, Ont
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