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Adverse events associated with prescription drug cost-sharing among poor and elderly persons.

https://arctichealth.org/en/permalink/ahliterature195424
Source
JAMA. 2001 Jan 24-31;285(4):421-9
Publication Type
Article
Author
R. Tamblyn
R. Laprise
J A Hanley
M. Abrahamowicz
S. Scott
N. Mayo
J. Hurley
R. Grad
E. Latimer
R. Perreault
P. McLeod
A. Huang
P. Larochelle
L. Mallet
Author Affiliation
McGill University Health Center, Royal Victoria Hospital Site, Ross Pavilion, Room 4-12, 687 Pine Ave W, Montréal, Quebec, Canada H3A 1A1.
Source
JAMA. 2001 Jan 24-31;285(4):421-9
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cost Sharing - legislation & jurisprudence
Drug Prescriptions - economics
Emergency Service, Hospital - utilization
Female
Health Policy
Health Services Accessibility - economics
Humans
Insurance, Pharmaceutical Services - economics - legislation & jurisprudence
Logistic Models
Male
Middle Aged
Patient compliance
Poisson Distribution
Poverty
Proportional Hazards Models
Quebec
Self Administration - economics - statistics & numerical data
Social Welfare
Socioeconomic Factors
Abstract
Rising costs of medications and inequities in access have sparked calls for drug policy reform in the United States and Canada. Control of drug expenditures by prescription cost-sharing for elderly persons and poor persons is a contentious issue because little is known about the health impact in these subgroups.
To determine (1) the impact of introducing prescription drug cost-sharing on use of essential and less essential drugs among elderly persons and welfare recipients and (2) rates of emergency department (ED) visits and serious adverse events associated with reductions in drug use before and after policy implementation.
Interrupted time-series analysis of data from 32 months before and 17 months after introduction of a prescription coinsurance and deductible cost-sharing policy in Quebec in 1996. Separate 10-month prepolicy control and postpolicy cohort studies were conducted to estimate the impact of the drug reform on adverse events.
A random sample of 93 950 elderly persons and 55 333 adult welfare medication recipients.
Mean daily number of essential and less essential drugs used per month, ED visits, and serious adverse events (hospitalization, nursing home admission, and mortality) before and after policy introduction.
After cost-sharing was introduced, use of essential drugs decreased by 9.12% (95% confidence interval [CI], 8.7%-9.6%) in elderly persons and by 14.42% (95% CI, 13.3%-15.6%) in welfare recipients; use of less essential drugs decreased by 15.14% (95% CI, 14.4%-15.9%) and 22.39% (95% CI, 20.9%-23.9%), respectively. The rate (per 10 000 person-months) of serious adverse events associated with reductions in use of essential drugs increased from 5.8 in the prepolicy control cohort to 12.6 in the postpolicy cohort in elderly persons (a net increase of 6.8 [95% CI, 5.6-8.0]) and from 14.7 to 27.6 in welfare recipients (a net increase of 12.9 [95% CI, 10.2-15.5]). Emergency department visit rates related to reductions in the use of essential drugs also increased by 14.2 (95% CI, 8.5-19.9) per 10 000 person-months in elderly persons (prepolicy control cohort, 32.9; postpolicy cohort, 47.1) and by 54.2 (95% CI, 33.5-74.8) among welfare recipients (prepolicy control cohort, 69.6; postpolicy cohort, 123.8). These increases were primarily due to an increase in the proportion of recipients who reduced their use of essential drugs. Reductions in the use of less essential drugs were not associated with an increase in risk of adverse events or ED visits.
In our study, increased cost-sharing for prescription drugs in elderly persons and welfare recipients was followed by reductions in use of essential drugs and a higher rate of serious adverse events and ED visits associated with these reductions.
Notes
Comment In: JAMA. 2001 May 9;285(18):2328-911343477
PubMed ID
11242426 View in PubMed
Less detail

Cost-effectiveness of self-managed versus physician-managed oral anticoagulation therapy.

https://arctichealth.org/en/permalink/ahliterature168750
Source
CMAJ. 2006 Jun 20;174(13):1847-52
Publication Type
Article
Date
Jun-20-2006
Author
Dean A Regier
Rubina Sunderji
Larry D Lynd
Kenneth Gin
Carlo A Marra
Author Affiliation
Collaboration for Outcomes Research and Evaluation, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC.
Source
CMAJ. 2006 Jun 20;174(13):1847-52
Date
Jun-20-2006
Language
English
Publication Type
Article
Keywords
Administration, Oral
Anticoagulants - administration & dosage - adverse effects - economics
Atrial Fibrillation - drug therapy - economics
Bayes Theorem
Canada
Cost of Illness
Cost-Benefit Analysis
Health Services Research
Heart Valve Prosthesis - economics
Humans
International Normalized Ratio
Markov Chains
National Health Programs
Outcome Assessment (Health Care)
Physician's Role
Quality-Adjusted Life Years
Self Administration - economics
Abstract
Patient self-management of long-term oral anticoagulation therapy is an effective strategy in a number of clinical situations, but it is currently not a funded option in the Canadian health care system. We sought to compare the incremental cost and health benefits of self-management with those of physician management from the perspective of the Canadian health care payer over a 5-year period.
We developed a Bayesian Markov model comparing the costs and quality-adjusted life years (QALYs) accrued to patients receiving oral anticoagulation therapy through self-management or physician management for atrial fibrillation or for a mechanical heart valve. Five health states were defined: no events, minor hemorrhagic events, major hemorrhagic events, thrombotic events and death. Data from published literature were used for transition probabilities. Canadian 2003 costs were used, and utility estimates were obtained from various published sources.
Self-management resulted in 3.50 fewer thrombotic events, 0.78 fewer major hemorrhagic events and 0.12 fewer deaths per 100 patients than physician management. The average discounted incremental cost of self-management over physician management was found to be 989 dollars (95% confidence interval [CI] 310 dollars-1655 dollars) per patient and the incremental QALYs gained was 0.07 (95% CI 0.06-0.08). The cost-effectiveness of self-management was 14,129 dollars per QALY gained. There was a 95% chance that self-management would be cost-effective at a willingness to pay of 23,800 dollars per QALY. Results were robust in probabilistic and deterministic sensitivity analyses.
This model suggests that self-management is a cost-effective strategy for those receiving long-term oral anticoagulation therapy for atrial fibrillation or for a mechanical heart valve.
Notes
Cites: J Thromb Thrombolysis. 2000 Apr;9(3):283-9210728029
Cites: Lancet. 2000 Mar 18;355(9208):956-6210768433
Cites: J Thromb Thrombolysis. 2000 Jun;9 Suppl 1:S13-910859580
Cites: J Thromb Thrombolysis. 2000 Jun;9 Suppl 1:S41-510859584
Cites: Lancet. 2000 Jul 8;356(9224):97-10210963245
Cites: Chest. 2001 Jan;119(1 Suppl):8S-21S11157640
Cites: Stroke. 2001 Jun;32(6):1425-911387509
Cites: Ann Thorac Surg. 2001 Nov;72(5):1523-711722037
Cites: Annu Rev Public Health. 2002;23:377-40111910068
Cites: Stroke. 2002 Apr;33(4):1034-4011935057
Cites: Stroke. 2002 Aug;33(8):2053-912154262
Cites: J Clin Pathol. 2002 Nov;55(11):845-912401823
Cites: Stroke. 2003 Feb;34(2):528-3612574571
Cites: Stroke. 2003 Apr;34(4):1056-8312677087
Cites: Med Decis Making. 2003 Jul-Aug;23(4):341-5012926584
Cites: Qual Life Res. 2004 Mar;13(2):427-3315085915
Cites: Chest. 2004 Sep;126(3 Suppl):204S-233S15383473
Cites: Can J Cardiol. 2004 Sep;20(11):1117-2315457308
Cites: Health Policy. 1990 Dec;16(3):199-20810109801
Cites: CMAJ. 1992 Feb 15;146(4):473-811306034
Cites: Thromb Haemost. 1993 Mar 1;69(3):236-98470047
Cites: N Engl J Med. 1995 Jul 6;333(1):11-77776988
Cites: Arch Intern Med. 1995 Nov 13;155(20):2185-97487240
Cites: Int J Technol Assess Health Care. 1995 Fall;11(4):796-78567213
Cites: Arch Intern Med. 1996 Jun 10;156(11):1197-2018639014
Cites: Lancet. 1996 Aug 17;348(9025):423-88709780
Cites: Eur J Cardiothorac Surg. 1997 May;11(5):935-429196312
Cites: JAMA. 1999 Jan 13;281(2):145-509917117
Cites: Semin Thromb Hemost. 1999;25(1):103-710327229
Cites: Disabil Rehabil. 1999 May-Jun;21(5-6):258-6810381238
Cites: Med Decis Making. 1999 Jul-Sep;19(3):265-7510424833
Cites: J Intern Med. 1999 Sep;246(3):309-1610475999
Cites: Ann Intern Med. 2005 Jan 4;142(1):1-1015630104
Cites: Int J Cardiol. 2005 Mar 10;99(1):37-4515721497
Cites: Z Kardiol. 2005 Mar;94(3):182-615747040
Cites: Lancet. 2006 Feb 4;367(9508):404-1116458764
Comment In: CMAJ. 2007 Mar 13;176(6):813; author reply 813-417353543
PubMed ID
16785459 View in PubMed
Less detail

Drug use in Estonia in 1994-1995: a follow-up from 1989 and comparison with two Nordic countries.

https://arctichealth.org/en/permalink/ahliterature205409
Source
Eur J Clin Pharmacol. 1998 Apr;54(2):119-24
Publication Type
Article
Date
Apr-1998
Author
R A Kiivet
U. Bergman
L. Rootslane
L. Rägo
F. Sjöqvist
Author Affiliation
University of Tartu, Department of Public Health, Estonia. rkiivet@ut.ee
Source
Eur J Clin Pharmacol. 1998 Apr;54(2):119-24
Date
Apr-1998
Language
English
Publication Type
Article
Keywords
Drug Prescriptions - economics - statistics & numerical data
Drug Utilization - economics - statistics & numerical data - trends
Economics, Pharmaceutical
Estonia
Finland
Humans
Nonprescription Drugs - economics
Self Administration - economics - statistics & numerical data - trends
Sweden
Abstract
To determine the patterns of drug use in Estonia for the years 1989 and 1994 1995, i.e. for the years before and after the pharmaceutical services in the country changed from a state monopoly to a competitive market.
The wholesale data from Estonia and the defined daily doses methodology were used. For comparison, national statistics on medicines from Finland and Sweden for the years 1994-1995 are shown.
The general sales of drugs in Estonia decreased almost twofold in all major pharmacological groups from 1989 to 1994 and subsequently increased by 10%-30% in 1995. Substantial differences in patterns of drug use between Estonia and the two Nordic countries were observed. The amount of prescription-only medicines used in Estonia was approximately 25% of that used in Finland and Sweden. The amount of over-the-counter drugs used was 61% of that used in Finland and 58% of that used in Sweden. In the drug use patterns in Estonia, some common trends can be noted: (1) persistent traditions, such as the low use of diuretics, beta-blockers, antithrombotics and inhalant anti-asthmatic drugs; (2) changes in prescription preferences--central anti-adrenergic drugs, pyrazolones, aminoglycosides and barbiturates are being replaced by calcium channel blockers and angiotensin-converting-enzyme inhibitors, propionic acid derivatives, cephalosporins and benzodiazepines, respectively; (3) rapidly increasing use of drugs not prescribed in the 1980s, such as hormonal contraceptives, opioids and antiulcer drugs, which strongly improves the quality of pharmacotherapy in Estonia.
The general trends in Estonia and the two Nordic countries are similar--the use of newer and more effective drugs is increasing and that of older ones decreasing. The changes are more rapid in Estonia than in Finland and Sweden, but, because of a short observation period, the use of newer drugs not yet prevailing. The international differences in drug utilization observed in this study may possibly be related mainly to the prescription preferences (e.g. therapeutic traditions) and less dependent on the respective health care systems (e.g. reimbursement schemes) and economic state of the country.
PubMed ID
9626915 View in PubMed
Less detail

[Economic analysis of self treatment with desmopressin. Nasal spray in bleeding. Cost saving].

https://arctichealth.org/en/permalink/ahliterature215815
Source
Lakartidningen. 1995 Feb 8;92(6):523-5
Publication Type
Article
Date
Feb-8-1995
Source
Ugeskr Laeger. 2002 Oct 7;164(41):4827
Publication Type
Article
Date
Oct-7-2002
Author
Benedikte Volfing
Source
Ugeskr Laeger. 2002 Oct 7;164(41):4827
Date
Oct-7-2002
Language
Danish
Publication Type
Article
Keywords
Denmark
Drug Costs
Humans
Methadone - administration & dosage - economics
Narcotics - administration & dosage - economics
Opioid-Related Disorders - rehabilitation
Self Administration - economics
Notes
Comment On: Ugeskr Laeger. 2002 Sep 2;164(36):419312362837
PubMed ID
12407897 View in PubMed
Less detail

A randomized trial of strategies for assessing eligibility for long-term domiciliary oxygen therapy.

https://arctichealth.org/en/permalink/ahliterature174744
Source
Am J Respir Crit Care Med. 2005 Sep 1;172(5):573-80
Publication Type
Article
Date
Sep-1-2005
Author
Gordon H Guyatt
Mika Nonoyama
Christina Lacchetti
Ron Goeree
Douglas McKim
Diane Heels-Ansdell
Roger Goldstein
Author Affiliation
Department of Medicine, McMaster University, Hamilton, Canada.
Source
Am J Respir Crit Care Med. 2005 Sep 1;172(5):573-80
Date
Sep-1-2005
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Anoxia - mortality - therapy
Canada
Costs and Cost Analysis
Female
Humans
Male
Middle Aged
Oxygen Inhalation Therapy - economics - mortality
Patient Selection
Quality of Life
Self Administration - economics
Abstract
Restricting oxygen administration to those who benefit is desirable.
To determine the impact of alternative strategies for assessing eligibility for domiciliary oxygen on funded oxygen use, quality of life, and costs.
We randomized applicants for domiciliary oxygen therapy to an assessment system that relied on data collected by oxygen providers at the time of application and judgments by Home Oxygen Program personnel (conventional assessment) or to a system of data collection by a respiratory therapist that included, in patients unstable at the time of initial assessment, a repeat assessment after 2 months of stability (alternative assessment).
A total of 276 applicants were allocated to the conventional arm and 270 to the alternative assessment. In the year after application, oxygen use was lower in the alternative arm with no between-group differences in mortality, quality of life, or resource use in the community. Although alternative assessment applicants had on average higher assessment costs by dollars Canadian 155 per applicant, these costs were more than offset by decreased Home Oxygen Program costs of dollars Canadian 596 per applicant using Canadian cost weights. The comparable U.S. dollar figures were dollars US 309 and dollars US 432, respectively, and the difference in cost between strategies was therefore smaller using U.S. cost weights.
Reassessment of applicants for domiciliary oxygen after several months of stability identifies an appreciable portion of initially eligible patients who are no longer eligible, thus reducing program costs to public funders without adverse consequences on quality of life, mortality, or other resource use.
Notes
Comment In: Am J Respir Crit Care Med. 2005 Sep 1;172(5):517-816120712
PubMed ID
15901604 View in PubMed
Less detail

Self-administration of intravenous antibiotics: an efficient, cost-effective home care program.

https://arctichealth.org/en/permalink/ahliterature243011
Source
Can Med Assoc J. 1982 Aug 1;127(3):207-11
Publication Type
Article
Date
Aug-1-1982
Author
H G Stiver
S K Trosky
D D Cote
J L Oruck
Source
Can Med Assoc J. 1982 Aug 1;127(3):207-11
Date
Aug-1-1982
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Anti-Bacterial Agents - administration & dosage
Child
Child, Preschool
Cost-Benefit Analysis
Home Care Services - economics
Humans
Infusions, Parenteral
Manitoba
Middle Aged
Pilot Projects
Self Administration - economics
Abstract
The effects of a home care program with 102 courses (2336 patient-days) of intravenous antibiotic therapy were evaluated. Home care nurses changed the intravenous cannula site every 3 days. The initial hospital stay averaged 11.8 days and the duration of home therapy averaged 22.9 days. The diseases treated included osteomyelitis, septic arthritis, endocarditis, cystic fibrosis and pneumonia, staphylococcal bacteremia, blastomycosis, actinomycosis and other soft tissue infections. All classes of commonly used antibiotics, including penicillins, cephalosporins, aminoglycosides and amphotericin B, were administered, alone or in combination. There were no side effects that necessitated discontinuation of home treatment or readmission to hospital. The average cost per patient-day was $58, compared with an estimated $193 for in-hospital therapy; in addition, 2336 hospital bed-days were made available. Most patients were able to resume many or all of their daily activities while receiving intravenous antibiotic therapy.
Notes
Cites: Am J Hosp Pharm. 1971 Oct;28(10):754-95125169
Cites: Ann Intern Med. 1973 Dec;79(6):848-504761911
Cites: Pediatrics. 1974 Sep;54(3):358-604213282
Cites: Surg Gynecol Obstet. 1976 Mar;142(3):373-61251318
Cites: Arch Intern Med. 1976 Mar;136(3):357-611259505
Cites: Am J Hosp Pharm. 1976 Jul;33(7):639-417955
Cites: Gastroenterology. 1976 Dec;71(6):943-53825411
Cites: N Engl J Med. 1977 Jun 9;296(23):1305-9323710
Cites: Am J Hosp Pharm. 1978 Mar;35(3):310-2626211
Cites: West J Med. 1978 Mar;128(3):203-6636409
Cites: Ann Intern Med. 1978 Nov;89(5 Pt 1):690-3717941
Cites: Arch Intern Med. 1979 Apr;139(4):413-5434994
Cites: Clin Nephrol. 1979 Mar;11(3):125-8436338
Cites: Public Health Rep. 1979 Jul-Aug;94(4):305-11112639
Cites: Clin Lab Haematol. 1979;1(1):13-27535301
Cites: Am J Hosp Pharm. 1980 Aug;37(8):1087-87405937
Cites: Ann Med Psychol (Paris). 1963 Jan;121(1):13-2714025028
PubMed ID
6809305 View in PubMed
Less detail

[The Danish trial with non-prescription drugs against stomach ulcer evaluated. An internationally unique drug reform caused a stagnant sale of drugs against stomach ulcer].

https://arctichealth.org/en/permalink/ahliterature226963
Source
Lakartidningen. 1991 Jan 16;88(3):150-2
Publication Type
Article
Date
Jan-16-1991

8 records – page 1 of 1.