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Levy J, Rosenberg M, Vanness D. A Transparent and Consistent Approach to Assess US Outpatient Drug Costs for Use in Cost-Effectiveness Analyses. Value Health 2018; 21:677-684. [PMID: 29909872 PMCID: PMC6394851 DOI: 10.1016/j.jval.2017.06.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/24/2017] [Accepted: 06/27/2017] [Indexed: 05/04/2023]
Abstract
BACKGROUND Assessment of drug costs for cost-effectiveness analyses (CEAs) in the United States is not straightforward because the prices paid for drugs are not publicly available and differ between payers. CEAs have relied on list prices that do not reflect the rebates and discounts known to be associated with these purchases. OBJECTIVES To review available cost measures and propose a novel strategy that is transparent, consistent, and applicable to all CEAs taking a US health care sector perspective or a societal payer's perspective. METHODS We propose using the National Average Drug Acquisition Cost (NADAC), the Veterans Affairs Federal Supply Schedule (VAFSS), and their midpoint as the upper bound, lower bound, and base case, respectively, to estimate net drug prices for various payers. We compare this approach with wholesale acquisition cost (WAC), the most common measure observed in our literature review. The minimum WAC is used to provide the most conservative comparison. RESULTS Our sample consists of 1436 brand drugs and 1599 generic drugs. On average, the upper bound (NADAC) is 1% and 9.8% lower than the WAC for brand and generic drugs respectively, whereas the lower bound (VAFSS) is 48.3% and 54.2% lower than the WAC. The NADAC is less than the WAC in 89.6% of drug groups. The distributions of these relationships do not show a clear mode and have wide variation. CONCLUSIONS Our study suggests that the WAC may be an overestimate for the base case because the minimum WAC is higher than the NADAC for most drugs. Our approach balances uncertainty and lack of data for the cost of pharmaceuticals with the need for a transparent and consistent approach for valid CEAs.
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Affiliation(s)
- Joseph Levy
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
| | - Marjorie Rosenberg
- Wisconsin School of Business, Department of Risk and Insurance, University of Wisconsin-Madison, Madison WI, USA
| | - David Vanness
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
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Vanness D, Preussler JM, Burns LJ, Denzen EM, Leppke SN, Majhail NS, Mupfudze T, Saber W, Silver A, Steinert P, Mau LW. Estimating Propensity Scores for the Receipt of Allogeneic Hematopoietic Cell Transplantation (AlloHCT) in Outcomes Research Using Claims Data: A Machine Learning Approach. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Preussler JM, Mau LW, Denzen EM, Majhail NS, Farnia SA, Silver A, Meyer C, Saber W, Vanness D. Administrative Claims Data for Cost Analyses in Hematopoietic Cell Transplantation: The Good, the Bad and the Ugly. Biol Blood Marrow Transplant 2015. [DOI: 10.1016/j.bbmt.2014.11.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Benedict A, Vanness D, Shaw J, Cifaldi M. FRI0412 Methodological issues when performing mixed treatment comparisons in rheumatoid arthritis: A sensitivity analysis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hanmer J, Vanness D, Gangnon R, Palta M, Fryback DG. Three methods tested to model SF-6D health utilities for health states involving comorbidity/co-occurring conditions. J Clin Epidemiol 2009; 63:331-41. [PMID: 19896802 DOI: 10.1016/j.jclinepi.2009.06.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 06/03/2009] [Accepted: 06/09/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Compare three commonly used methods to combine the impacts of multiple health conditions on SF-6D health utility scores. STUDY DESIGN AND SETTING We used data from the 1998-2004 Medicare Health Outcomes Survey to compare three commonly suggested models of multiple health conditions' impacts on health-related quality of life: additive, minimum, and multiplicative. We modeled SF-6D scores using information about 15 health conditions, both unadjusted and adjusted for age, sex, education, and income. Model performance was assessed using mean squared error, mean predictive error by number of health conditions, and mean predictive error for groups with specific combinations of health conditions. RESULTS Ninety-five thousand one hundred ninety-five observations were used for model estimation, and 94,794 observations were used for model testing. The adjusted models always had better performance than the unadjusted models. The multiplicative model showed smaller mean predictive error than the other models in both those younger than 65 years and those 65 years and older. Mean predictive error for the multiplicative model was generally within the minimally important difference of the SF-6D. CONCLUSION All tested models are imperfect in these Medicare data, but the multiplicative model performed best.
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Affiliation(s)
- Janel Hanmer
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI 53703, USA.
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Siewert B, Gareen I, Vanness D, Herman B, Johnson CD, Gatsonis C. ACRIN 6664: Patient acceptance and preferance of CT colonography compared to optical colonoscopy for colon cancer screening. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4034 Background: Colorectal cancer screening must be repeated on a regular basis. Understanding patient perceptions and willingness to be rescreened will help to determine future compliance rates. The purpose of this study was to compare National CT Colonography Trial (NCTCT) screening participant experiences with CT colonography (CTC) and optical colonoscopy (OC), willingness to return for each procedure, and procedure preference. Methods: NCTCT participants underwent a single bowel preparation (BP). Participants were scheduled to receive CTC, followed by sedation and OC. Participants were asked to complete a questionnaire two weeks post-exam on physical discomfort and embarrassment during BP, CTC and OC and willingness to repeat CTC and OC (with or without BP) at different time intervals. McNemar's Test and logistic regression were used for statistical analysis. Results: 2310 of 2600 patients (89%) responded (1224 women, 1086 men). Mean age was 58.39 years (range 50–86). The participant population was 85% Caucasian, 11% African American and 4% other. Severe discomfort was reported by 7.1% participants with BP, 6.3% with CTC, and 2.2% with OC. Severe embarrassment was reported by 1.6% participants with BP, 1.3% with CTC, and 0.7% with OC. Forty-six percent of participants preferred CTC, 27.4% reported no preference, and 24.9% preferred OC (p<0.001). Repeat screening with CTC is currently recommended every 5 years and with OC every 10 years. 80.5% of the participants were willing to be screened again with CTC in 5 years and 97.5 % were willing to be screened again with OC in 10 years (p<0.001). If the screening interval for CTC were extended to ten years, 93.7% of participants were willing to return for screening (p<0.001). If BP were unnecessary, 91.0% were willing to be rescreened with CTC in 5 years and 97.5% were willing to be rescreened with OC in 10 years (p<0.001). Conclusions: NCTCT participants preferred CTC to OC, but their willingness to undergo repeat CTC was limited by the shorter interval between screenings currently recommended for CTC as opposed to OC. Improvements in technology that would eliminate the need for bowel preparation or extend the recommended screening interval would likely improve adherence to recommended repeat screening. [Table: see text]
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Affiliation(s)
- B. Siewert
- Beth Israel Deaconess Medical Center, Boston, MA; Brown University, Providence, RI; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ
| | - I. Gareen
- Beth Israel Deaconess Medical Center, Boston, MA; Brown University, Providence, RI; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ
| | - D. Vanness
- Beth Israel Deaconess Medical Center, Boston, MA; Brown University, Providence, RI; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ
| | - B. Herman
- Beth Israel Deaconess Medical Center, Boston, MA; Brown University, Providence, RI; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ
| | - C. D. Johnson
- Beth Israel Deaconess Medical Center, Boston, MA; Brown University, Providence, RI; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ
| | - C. Gatsonis
- Beth Israel Deaconess Medical Center, Boston, MA; Brown University, Providence, RI; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ
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Abstract
Classifying patients as "active" or "passive" with regard to healthcare decision making is misleading, since patients have different desires for different components of the decision-making process. Distinguishing patients' desired roles is an essential step towards promoting care that respects and responds to individual patients' preferences. We included items on the 2004 Wisconsin Longitudinal Study mail survey measuring preferences for four components of the decision-making process: physician knowledge of patient medical history, physician disclosure of treatment choices, discussion of treatment choices, and selection of treatment choice. We characterized preference types for 5199 older adults using cluster analysis. Ninety-six percent of respondents are represented by four preference types, all of which prefer maximal information exchange with physicians. Fifty-seven percent of respondents wanted to retain personal control over important medical decisions ("autonomists"). Among the autonomists, 81% preferred to discuss treatment choices with their physician. Thirty-nine percent of respondents wanted their physician to make important medical decisions ("delegators"). Among the delegators, 41% preferred to discuss treatment choices. Female gender, higher educational attainment, better self-rated health, fewer prescription medications, and having a shorter duration at a usual place of care predicted a significantly higher probability of the most active involvement in discussing and selecting treatment choices. The overwhelming majority of older adults want to be given treatment options and have their physician know everything about their medical history; however, there are substantial differences in how they want to be involved in discussing and selecting treatments.
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Affiliation(s)
- Kathryn E. Flynn
- Center for Clinical and Genetic Economics, Duke Clinical
Research Institute, P.O. Box 17969, Durham, NC, 27715, Phone: (919) 668-6417.
Fax: (919) 668-7124.
| | - Maureen A. Smith
- Department of Population Health Sciences, University of
Wisconsin Medical School, #505 WARF Bldg., 610 Walnut St., Madison,
WI, 53726, Phone: (608) 262-4802. Fax: (608) 263-2820.
| | - David Vanness
- Department of Population Health Sciences, University of
Wisconsin Medical School, #785 WARF Bldg., 610 Walnut St., Madison,
WI, 53726, Phone: (608) 265-8600. Fax: (608) 263-2820.
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Rongey C, Bambha K, Vanness D, Pedersen RA, Malinchoc M, Therneau TM, Dickson ER, Kim WR. Employment and health insurance in long-term liver transplant recipients. Am J Transplant 2005; 5:1901-8. [PMID: 15996237 DOI: 10.1111/j.1600-6143.2005.00961.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This study was conducted to examine factors affecting health insurance and employment status in long-term liver transplant (OLT) recipients. All adult primary OLT recipients surviving at least 1 year were surveyed using existing questionnaires. Out of 217 eligible recipients, 186 (86%) responded. The median age of respondents was 55 years with a median survival after OLT of 3.4 years. The majority (98%) of respondents had health insurance coverage. Thirty-four (18%) reported having lost and/or having been denied health insurance since OLT, and 63 (34%) switched health insurance since OLT. Of the 179 that reported employment status, 98 (55%) were employed, including homemakers and students, while 39 (22%) were retired and 42 (24%) unemployed. The majority (76%) of those unemployed cited poor health as the reason for unemployment, followed by 5 (12%) who feared loss of disability or Medicaid benefits. Fourteen reported to have been denied or terminated from employment because of their transplant. In the regression analysis, employment prior to transplantation (odds ratio (OR)=5.1), age less than 57 (OR=5.1), physical function score>52.4 (OR=3.6) and general health score>33.3 (OR=7.6) were significantly associated with employment. These data may help identify high-risk pre-OLT patients for intervention measures such as work rehabilitation.
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Affiliation(s)
- Catherine Rongey
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Huddleston JM, Long KH, Naessens JM, Vanness D, Larson D, Trousdale R, Plevak M, Cabanela M, Ilstrup D, Wachter RM. Medical and surgical comanagement after elective hip and knee arthroplasty: a randomized, controlled trial. Ann Intern Med 2004; 141:28-38. [PMID: 15238368 DOI: 10.7326/0003-4819-141-1-200407060-00012] [Citation(s) in RCA: 166] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hospitalists are assuming an increasing role in the care of surgical patients, but the impact of this model of care on postoperative outcomes is unknown. OBJECTIVE To determine the impact of providing a collaborative, hospitalist-led model of care on postoperative outcomes and costs among patients having hip or knee arthroplasty. DESIGN Randomized, controlled trial. SETTING Academic medical center. PARTICIPANTS 526 patients having elective orthopedic surgery who are at elevated risk for postoperative morbidity. MEASUREMENTS Length of stay, inpatient postoperative medical complications, health care provider satisfaction, and inpatient costs. INTERVENTIONS A comanagement medical Hospitalist-Orthopedic Team compared with standard postoperative care by orthopedic surgeons with medical consultation. RESULTS More patients in the hospitalist group were discharged from the hospital with no complications (61.6% vs. 49.8%; difference, 11.8 percentage points [95% CI, 2.8 to 20.7 percentage points]). Fewer minor complications were observed among hospitalist patients (30.2% vs. 44.3%; difference, -14.1 percentage points [CI, -22.7 to -5.3 percentage points]). Observed length of stay was not statistically different between treatment groups. However, when adjusted for discharge delays, mean length of stay for patients in the hospitalist model of care was shorter (5.1 days vs. 5.6 days; difference, -0.5 day [CI, -0.8 to -0.1 day]). Total costs did not differ between groups. Orthopedic surgeons and nurses preferred the hospitalist model. LIMITATIONS Care providers and patients were aware of intervention assignments, and the study could not capture all costs associated with the hospitalist model. CONCLUSIONS The comanagement medical Hospitalist-Orthopedic Team model reduced minor postoperative complication rates with no statistically significant difference in length of stay or cost. The nurses and surgeons strongly preferred the comanagement hospitalist model. Additional research on the clinical and economic impact of the hospitalist model in other surgical populations is warranted.
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MESH Headings
- Aged
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/economics
- Arthroplasty, Replacement, Hip/standards
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/economics
- Arthroplasty, Replacement, Knee/standards
- Attitude of Health Personnel
- Female
- Hospital Costs
- Hospitalists
- Humans
- Internal Medicine
- Length of Stay
- Male
- Middle Aged
- Orthopedics
- Outcome Assessment, Health Care
- Patient Care Team
- Postoperative Complications/prevention & control
- Risk Factors
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