Common head and neck cancer treatment pathways and associated costs in the U.S. commercial managed care population

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Background: For the treatment of head and neck cancer (HNC), different modalities (chemotherapy, radiation, surgery, or chemoradiotherapy) can be used either independently or in combination with others. Information regarding real-world treatment pattern is limited. The purpose of this study was to identify common treatment pathways and associated costs. Methods: The study was performed using data from a large U.S. commercial managed care claims database. Adult subjects (≥18) diagnosed with HNC between January 1, 2006, to December 31, 2006, (index-period) were identified based on a pre-selected ICD-9-CM codes. All subjects were HNC diagnosis-naïve 12 months prior to their index dates (first date of HNC diagnosis) and followed for 12 months post index date. Treatment modalities were identified based on the Healthcare Common Procedure Coding System used in the U.S. Pathways were constructed by reflecting time of and between modality administration claims. Results: 6,570 subjects were identified. The average age was 61 years (±14.9) and 44% (n = 2869) were female. Midwest (31%) and east (31%) region had a higher (p < 0.01) representation, compared to south (20%) and west (18%). Only 2,257 subjects (34%) received some type of treatment modality and were categorized into 20 mutually exclusive treatment pathways. Of these, 82% (n = 1,843) received single modality, 18% (n = 398) received a combination of 2, and 0.7% (n = 16) received a combination of 3 modalities. Among single modality pathways, radiation (34%; n = 619) was most common, however, cheomoradiotherapy (26%; n = 485) had the highest average patient cost ($98,440). Within double modalities, radiation followed by chemotherapy (24%; n = 95) was most common, however, chemoradiotherapy followed by surgery (4%; n = 16) had the highest average cost ($146,374). Within triple modalities, surgery followed by radiation then chemotherapy (50%; n = 8) was most common and costly ($95,868). Conclusions: The most common treatment pathways one year post HNC diagnosis used a single modality; however, the average patient costs within multiple modalities were higher. Further study is required to investigate if these patterns are comparable to current guideline recommendation.

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Healthcare Resource Utilization and Costs of Mild, Moderate, and Severe Depression in the Workforce in the United States

Objective:

Document the healthcare resource utilization and costs by severity for persons in the workforce with major depressive disorder (MDD).

Methods:

Using the National Comorbidity Survey-Replication data, workforce respondents (n=4,465) were categorized by clinical severity (not clinically depressed, mild, moderate, severe) using standard scales (CIDI/QIDS-SR). Outcomes measured over 12 months included prevalence of medical services/antidepressant use, average number of visits and days on antidepressants, prevalence of treatment adequacy, and medical/drug costs. Costs represent insurer payments to providers and were estimated by weighting utilization measures by unit costs obtained for similar services used by depressed patients in a U.S. employer claims database for the corresponding period (2000-2001). Outcomes were compared across depression severity groups using multivariate analyses adjusting for demographics.

Results:

Among the 539 depressed workforce respondents, 13.8% were mildly, 38.5% moderately and 47.7% severely depressed. A significant association existed between severity and prevalence of mental health services usage (19.1%, 27.2%, and 40.3% respectively, p< 0.01) and average number of mental health practitioner visits. The use of antidepressants increased with depression severity (21.1%, 27.3%, and 39.5% respectively, p< 0.01). Similarly, the adequacy of mental health services increased with depression severity (6.2%, 11.8%, and 21.3% respectively, p< 0.05). Average 12-month costs per MDD patient were substantially higher for severe vs. mild (mental health services: $697 vs. $388; general medical services: $138 vs. $53; anti-depressant usage $256 vs. $88).

Conclusions:

Among workforce respondents, there was a significant association between depression severity and treatment usage and costs, and between treatment adequacy and severity.

The potential unintended economic consequences of the Medicine Equity and Drug Safety Act of 2000

BACKGROUND

The Medicine Equity and Drug Safety (MEDS) Act of 2000 was passed by Congress in October 2000 in response to the perception that US pharmaceutical prices and expenditures were rising too quickly and that many people could no longer afford their medication. The Act was terminated at the end of December 2000 for lack of the congressionally required certification by the Department of Health and Human Services of 2 key conditions written into the law. Under the terms of the MEDS Act, pharmacists and wholesalers would have been able to reimport lower-priced pharmaceuticals into the United States from other countries.

OBJECTIVE

In this article, we formulate an economic model as the basis for determining the probable unintended effects of the MEDS Act and propose an alternative policy that would achieve the objectives of the MEDS Act.

METHODS

An economic model of parallel trade in the pharmaceutical industry was used to demonstrate the likely effects of the MEDS Act.

RESULTS

Although in most markets the effects of parallel trade would increase economic efficiency, in the pharmaceutical industry parallel trade would be detrimental to long-term economic efficiency. By encouraging parallel trade into the United States, the Congress would, in effect, be introducing pharmaceutical price controls from other countries that have price controls. Parallel trade erodes price differences across countries and hence undermines the most efficient pricing mechanism for paying for research and development.

CONCLUSION

Although the MEDS Act was terminated, important policy lessons can be learned for consideration in the creation of any similar future legislation designed to control pharmaceutical prices.