Projecting future drug expenditures--2003.

Drug expenditure projections for 2003 and factors likely to influence drug costs are discussed. The United States continues to face the challenge of increased growth in health expenditures, and drug expenditures are continuing to increase faster than the growth in total health care expenditures. These increases can be largely attributed to an increase in the average age of the U.S. population and technological advancement. On the basis of price inflation and non-price inflationary factors, including increases in volume, shifts in patient and therapeutic intensity, and expected approval of new drugs, a 10-12% increase in drug expenditures in 2003 for the inpatient setting and a 13.5-15.5% increase for ambulatory care settings are forecasted. While few new drugs are expected to greatly influence expenditures in 2003, the continued diffusion of recently approved drugs such as drotrecogin alfa and nesiritide will have a dramatic impact on total drug expenditures and must be carefully considered in the budgeting process. An agent likely to have a significant impact on HIV treatment is enfuvirtide, the first in a new class of antiretrovirals (fusion inhibitors), but its high cost ($10,000-$15,000 per year) may limit patients' access to this medication. An expanded user's guide is provided to assist the reader in appropriate application of this information in the drug budgeting process. Technological, demographic, and market-based changes and changes in public policy will continue to influence pharmaceutical expenditures in the coming year. An understanding of the overall drivers of medication expenditures and vigilance in monitoring pharmaceutical innovation are critical in the effective management of these resources.     

The impact of racial and ethnic disparities in inhaled corticosteroid adherence on healthcare expenditures in adults with asthma

Purpose: The purpose of this study is to determine racial and ethnic disparities with the adherence to inhaled corticosteroids (ICSs) in adults with persistent asthma, and their association with healthcare expenditures.

Methods: A retrospective, cross-sectional study using the Medical Expenditure Panel Survey (MEPS) 2013–2014 data included patients ≥18 years with persistent asthma. Median medication possession ratio (MPR) was used to dichotomize adherence levels. Multivariate regression analysis was conducted to ascertain the association between adherence and race/ethnicity. Total expenditures and association with adherence were analyzed using a generalized linear model with a log link function and gamma distribution. Unadjusted expenditures were compared after bootstrapping.

Results: The average MPR of ICSs for the sample of 277 patients was 0.34. The average MPR level was 0.33 among whites, 0.37 among African-Americans and 0.35 among other minorities. The average MPR was 0.30 among Hispanics, and 0.35 among non-Hispanics. African-Americans were less likely to be adherent than whites (OR 0.95). Hispanics were less likely to be adherent (OR 0.4; CI 0.206–0.777). Higher adherence was associated with significantly higher total health expenditure than lower adherence ($19,223 vs. $12,840 respectively, p?<?.0001). African-Americans had slightly higher total expenditure compared to whites; however, other minorities had significantly lower health expenditures compared to whites (p?=?.01). Non-Hispanics spent significantly less on healthcare compared to Hispanics (p?=?.04).

Conclusions: Valuable insight into the economic cost of the disparities as they relate to persistent asthma provides further evidence of possible ethnic inequities that warrant addressing.     

Healthcare expenditures and patient satisfaction: cost and quality from the consumer's perspective in the US*

ABSTRACT

Background: Both cost and quality of healthcare are major concerns in the United States. Using patient satisfaction as a quality indicator, we seek to identify the relationship between healthcare cost and quality from the perspective of the community-dwelling population in the United States.

Methods: We examined a nationally representative sample of 13?980 adults (age?≥?18 years) in the 2003 Medical Expenditure Panel Survey (MEPS). Given the idiosyncrasies of the cost data distribution, a recently developed extended estimating equation (EEE) model was employed to identify the relationship between patient satisfaction and healthcare expenditure, after controlling for individual demographic covariates, co-morbidity profile, and functional and activity limitations. A series of sensitivity analyses were conducted, in addition, to verify the identified relationship. All statistics were adjusted using the proper sampling weight from the MEPS data.

Results: Average annual healthcare expenditures for 2003 ranged between $3923 and $6073 when grouped by patient satisfaction ratings with a mean value $4779 for all individuals who rated perceived satisfaction of their healthcare. We found that there is no statistically signif­icant relationship between patient satisfaction and total healthcare expenditure (?p?=?0.60) and a non-monotonic relationship is not identified either. All sensitivity analyses results revealed a lack of relationship between patient satisfaction and healthcare expenditures.

Limitations: Patient satisfaction might not reflect the quality of healthcare from an objective clinical standpoint. The identified cost–satisfaction relationship may not be extrapolated to other quality indicators. Due to the cross-sectional study design, no causal relationship could be inferred between patient satisfaction and healthcare expenditure.

Conclusions: Our study adds to the literature on health­care cost and quality by suggesting that the improvement of patient satisfaction may not require additional health­care spending.     

Projecting future drug expenditures--2004.

PURPOSE: Drug expenditure trends since 2002 and projected drug expenditures for 2004 are discussed. SUMMARY: In 2002 there was a moderation in the trend of increasing drug expenditures. Drug expenditures increased by 12.3% between 2001 and 2002. This trend continued in the first half of 2003, with expenditures increasing by only 10% compared with 2002. This moderation in the drug expenditures trend can be attributed to many factors, especially patent expirations and decreases in new drug approvals. Higher cost sharing for consumers and a general economic slowdown in the United States affecting employment and insurance coverage have resulted in a smaller increase in drug utilization. In 2004, there should be a 10-12% increase in drug expenditures for outpatient settings, a 19-21% increase for clinics, and a 6-8% increase for hospitals. CONCLUSION: Drug expenditure growth should continue to outpace the growth in overall health care expenditures and the growth in the U.S. economy.     

Evaluation of the association between health insurance status and healthcare utilization and expenditures among adult cancer survivors in the United States

BackgroundHealth care expenditures for cancer care has increased significantly over the past decade and is further projected to rise. This study examined the associations between health insurance status and total direct health care expenditures and health care utilization among cancer survivors living in the United States.MethodsA cross-sectional study of cancer survivors aged ≥18 years, identified from the Medical Expenditures Panel Survey (MEPS) during 2017 using International Classification of Diseases, Tenth Revision codes specific for cancer. Health insurance was categorized into Private, Medicare, Medicaid, and uninsured. Multivariable ordinary least squares regression was used to examine the association between log expenditures and health insurance. Negative binomial regression with log link was used to obtain adjusted incident rate ratios (AIRR) for health care utilization. Survey weights were used to produce nationally representative estimates of the US population.ResultsA total of 1140 (weighted = 13.9 million) cancer survivors were identified. Compared to the adjusted mean annual health care expenditures for the private group ($14,265; 95% confidence interval (CI): $12,645 to $16,092), the adjusted mean annual health care expenditures for the Medicare group were higher ($15,112; 95%CI: $13,361 to $17,092). As compared to the private group, the average annual expenditures for uninsured cancer survivors ($2315; 95%CI:1038 to $3501) was significantly lower and so was their health care utilization. Adjusted rates of ER visits for Medicaid were twice (AIRR:2.04; SE:0.28; p = 0.001) as compared to privately insured.ConclusionsA difference in the average total direct expenditures between uninsured and privately insured patients was found. Uninsured had the lowest health care utilization while Medicaid reported significantly higher number of ER visits. Despite differences in program structures, health care expenditures across insurance types were similar. Lower utilization of health care services among uninsured suggests cost maybe a barrier to accessing care.     

The size and mix of government spending on illicit drug policy in Australia

Aim . To estimate how much governments in Australia spend on reducing and dealing with illicit drug problems. Methods . Government documents and supplementary information sources were used to estimate drug‐related expenditure for the financial year 2002–03, in Australian dollars. Public sector expenditure on reducing drug problems (‘proactive expenditure’) was classified into four policy functions: prevention, treatment, harm reduction and enforcement. Expenditure related to the consequences of drug use (‘reactive expenditure’) was included as a separate category. Results . Spending by Australian governments in financial year 2002–03 on all drug‐related activities was estimated to be $3.2 billion. Proactive expenditure was estimated to be $1.3 billion, comprising 55% on enforcement, 23% on prevention, 17% on treatment, 3% on harm reduction and 1% on activities that span several of these functions. Expenditure on dealing with the consequences of drug use was estimated to be $1.9 billion, with the majority the result of crime‐related consequences. Conclusion . Several insights result from estimating these expenditures. First, law enforcement is the largest drug policy component, with Australian governments also spending significant amounts on treatment and prevention programmes. Secondly, apart from the prevention component, Australia's drug policy mix is strikingly similar to recent international estimates. Finally, expenditures associated with dealing with the consequences of illicit drugs are large and important for assessing drug‐related public sector expenditure.     

Australian governments' spending on preventing and responding to drug abuse should target the main sources of drug-related harm and the most cost-effective interventions

A notable feature of Australian drug policy is the limited public and professional attention given to the financial costs of drug abuse and to the levels and patterns of government expenditures incurred in preventing and responding to this. Since 1991, Collins and Lapsley have published scholarly reports documenting the social costs of drug abuse in Australia and their reports also contain estimates of governments' drug budgets: revenue and expenditures. They show that, in 2004-2005, Australian governments expended at least $5288 million on drug abuse, with 50% of the expenditure directed to preventing and dealing with alcohol-related problems, 45% to illicit drugs and just 5% to tobacco. Some 60% of the expenditure was directed at drug crime and 37% at health interventions. This pattern of resource allocation does not adequately reflect an evidence-informed policy orientation in that it largely fails to focus on the drug types that are the sources of the most harm (tobacco and alcohol rather than illicit drugs), and the sectors for which we have the strongest evidence of the cost-effectiveness of the available interventions (treatment and harm reduction rather than legislation and law enforcement). The 2010-2014 phase of Australia's National Drug Strategy should include incremental changes to the resource allocation mix, and not simply maintain the historical resource allocation formulae.     

Impact of inappropriate drug use among hospitalized older adults

Objective Criteria for inappropriate drug use developed by Beers have been widely used in drug utilization reviews as the basis for educational materials and to assess the quality of prescribing. However, there is inconclusive evidence that these criteria can impact on patient outcomes. The objective of this study was to evaluate the impact of inappropriate drug use on all-cause mortality, adverse drug reactions (ADRs) and length of stay among in-hospital patients.Methods We performed a retrospective, cohort study on 5,152 patients aged 65 years or older admitted to 81 hospitals in Italy between 1997 and 1998. Inappropriate drug use was defined by 2003 Beers criteria. Outcomes of the study were: (a) in-hospital mortality; (b) incidence of ADR occurring during hospital stay; (c) length of hospital stay 13 days or more.Results The mean age of 5,152 participants was 78.8 years (standard deviation = 8.4 years), and 2,463 (47.8%) were men. During hospital stay, 1,475 (28.6% of the study sample) patients received one or more inappropriate drugs. After adjusting for potential confounders, use of inappropriate drugs was not associated significantly with either mortality [odds ratio (OR) 1.05; 95% confidence intervals (CI): 0.75–1.48], ADR (OR 1.20; 95% CI: 0.89–1.61) or length of stay 13 days or more (OR 1.09; 95% CI: 0.95–1.25).Conclusions This study did not show any significant effect of inappropriate drug use defined by Beers 2003 criteria on health outcomes among hospitalized older adults. Further studies conducted in different settings, using additional health outcomes and alternate measures of inappropriate drug use, are needed.     

Projecting future drug expenditures--2008.

PURPOSE: Drug expenditure trends in 2006 and 2007, projected drug expenditures by setting for 2008, and factors likely to influence drug expenditures are discussed. SUMMARY: Various factors are likely to influence drug expenditures in 2008, including drugs in development, the diffusion of new drugs, drug safety concerns, generic drugs, Medicare Part D, and changes in the drug supply chain. The increasing availability of important generic drugs and drug safety concerns continue to moderate growth in drug expenditures. The drug supply chain remains dynamic and may influence drug expenditures, particularly in specialized therapeutic areas. Initial data suggest the Medicare Part D benefit has influenced drug expenditures, but the ultimate impact of the benefit on drug expenditures remains unclear. From 2005 to 2006, total drug expenditures increased by 8.7% to $275 billion. Drug expenditures in clinics continue to grow more rapidly than in other settings, with a 20.9% increase from 2005 to 2006, and drug expenditures in clinics are now greater than the amount spent in hospitals. Hospital drug expenditures increased at a moderate rate of only 3.8% from 2005 to 2006; through the first nine months of 2007, hospital drug expenditures increased by only 2.2% compared with the same period in 2006. CONCLUSION: In 2008, we project a 5-7% increase in drug expenditures in outpatient settings, a 12-14% increase in clinics, and a 4-6% increase in hospitals.