Sulfonylurea pharmacotherapy regimen adherence in a Medicaid population: influence of age, gender, and race.
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Adolescent↗
Biomedical subjects
L M Robison
Publications and source records attributed to L M Robison.
Antidepressant pharmacotherapy: economic evaluation of fluoxetine, paroxetine and sertraline in a health maintenance organization.
The present study was designed to compare direct health service expenditures, for the treatment of depression, among patients enrolled in a health maintenance organization, and prescribed one of three selective serotonin reuptake inhibitors, fluoxetine, paroxetine or sertraline. Information regarding depression-related health service use was derived from the computer archive of a network-model health maintenance organization system serving 700,000 beneficiaries. A total of 744 health maintenance organization beneficiaries were found to satisfy the study selection criteria. Multivariate regression analysis was used to determine the incremental influence of selected demographic, clinical, financial and provider characteristics on health service expenditures related to the treatment of depression (ICD-9-CM, or DSM-IV code 296.2) 1 year after the start of antidepressant pharmacotherapy. Multivariate findings indicate that treatment with paroxetine increases average expenditures for physician visits ($31.93; P < or = 0.05), psychiatric visits ($19.33; NS), laboratory tests ($2.35; P < or = 0.05), hospitalizations ($85.33; P < or = 0.05), psychiatric hospitalizations ($82.01; P < or = 0.05), and antidepressant pharmacotherapy ($63.72; P < or = 0.05), for a total per capita increase in health service use of $284.68 (P < or = 0.05), compared with treatment with fluoxetine. Sertraline treatment increases average expenditures for physician visits ($21.74; P < or = 0.05), psychiatric visits ($56.79; P < or = 0.05), laboratory tests ($1.21; P < or = 0.05), hospitalizations ($70.59; P < or = 0.05), psychiatric hospitalizations ($95.75; P < or = 0.05), and antidepressant pharmacotherapy ($69.85; P < or = 0.05), for a total per capita increase in health service use of $315.96 (P < or = 0.05), compared with treatment with fluoxetine. Economic comparisons between paroxetine and sertraline did not demonstrate any significant differences in expenditures for the health services examined.
1-Naphthylamine↗
Prescribing rationale and budgetary outcomes associated with the introduction of a combined formulation of diclofenac sodium and misoprostol in Canada.
The budgetary impact of prescribing a combined formulation of diclofenac sodium and misoprostol to patients previously using nonsteroidal anti-inflammatory agents (NSAIDs), cytoprotective agents, or a combination of agents from both therapeutic categories is assessed, as is the clinical rationale for prescribing the combined formulation. Analysis of data for Canada on claims paid by third parties showed that the use of the combined formulation in Canada had resulted in significant initial overall savings and that the greatest cost savings were made for those who had previously used both an NSAID and a cytoprotective concomitantly. The inclusion of shadow costs (secondary costs) indicates that the use of the combined formulation over a 6-month period involves very low shadow costs (medical expenses related to ulcer treatment) compared with other NSAIDs: the shadow cost multiplication factor was 1.03 for the combined formulation compared with 1.22 to 3.47 for other NSAIDs. Pharmaceutical costs alone are insufficient for evaluating total budgetary impacts.
Anti-Inflammatory Agents, Non-Steroidal↗
Metered-dose inhaler technique and quality of life with airways disease: assessing the value of the Vitalograph in educational intervention.
The efficacy of delivering medicines by metered-dose inhaler (MDI) is well established, and the patient's technique with MDIs is related directly to achieving the desired clinical outcome. The present study was designed to assess and improve MDI technique by using a Vitalograph Aerosol Inhalation Monitor (VAIM) in an airways disease education programme. Baseline measurements were made immediately prior to educational intervention incorporating feedback from a VAIM unit. At 6 weeks' follow-up, MDI technique was found to have regressed to the sub-optimal measures recorded at baseline prior to educational intervention. However, patients reported a significant improvement in physical function between baseline and follow-up as measured by the Rand 36-Item Health Survey (SF-36), Version 1.0. The results reinforce the need for a longitudinal educational programme for patients prescribed medications delivered by MDI. The VAIM unit provided health educators and patients with both a visual and a quantitative assessment of patients' MDI technique, and was thus of positive value as part of the intervention process.
Adult↗
Ipratropium bromide in the management of chronic obstructive pulmonary disease: effect on health service expenditures.
Chronic obstructive pulmonary disease (COPD), which is estimated to affect 32 million Americans, is the fifth leading cause of death in the United States. This retrospective study was designed to discern the economic utility of initial pharmacotherapy with various individual drugs in the management of COPD, as well as subsequent costs incurred as disease progression necessitated combination therapy. Data for this analysis were derived from the computer archive of a network-model health maintenance organization. During the first 6 months post-diagnosis for COPD, results indicated a significant (P < or = 0.05) increase in expenditures for physicians, hospital care, and total health service utilization for patients prescribed theophylline, a corticosteroid (triamcinolone or beclomethasone) delivered via a metered-dose inhaler, or albuterol delivered via a metered-dose inhaler as initial monotherapy compared with patients prescribed ipratropium bromide (IB) delivered via a metered-dose inhaler. Patients receiving initial pharmacotherapy with ipratropium bromide and subsequently adding albuterol used significantly less health care services (P < or = 0.05) during the first 15 months post-diagnosis for COPD than did patients prescribed all other combination therapies we evaluated.
Female↗
Effect of pharmaceutical formulation for antihypertensive therapy on health service utilization.
A significant factor in the management of hypertension is the extent to which patients comply with the treatment regimen. A retrospective analysis was undertaken to determine the relationship between antihypertensive formulation, regimen compliance, and the utilization of health care services. Data for this analysis were derived from the state of South Carolina's Medicaid computer archive. The study population consisted of 1000 randomly selected patients initially prescribed one of the following antihypertensive regimens as monotherapy: atenolol once daily, captopril BID, oral clonidine BID, transdermal clonidine once weekly, diltiazem BID, enalapril BID, metoprolol BID, prazosin BID, terazosin once daily, and sustained-release verapamil once daily. Multivariate regression analysis was used to determine the incremental influence of selected demographic characteristics, use of medical services before diagnosis of hypertension, initial antihypertensive medication, medication possession ratio for antihypertensive therapy, and number of maintenance medications for diseases other than hypertension on post-period health care expenditures. The results indicated that patients initially prescribed antihypertensive medication requiring once-daily or once-weekly administration experienced an increased utilization of antihypertensive medication, needed fewer changes in their therapeutic regimen, and far less need for concomitant therapy for blood pressure control compared with those prescribed a BID regimen. Patients in the once-daily or once-weekly groups also used significantly fewer physician, hospital, and laboratory services (P < or = 0.05).
Adult↗
Dietary intake as a risk factor for cancer of the exocrine pancreas.
Data from 149 cases with pancreatic cancer and 363 control subjects in Utah were obtained from proxy respondents to assess the associations between dietary intake and the development of pancreatic cancer. After adjusting for cigarette smoking status and alcohol and coffee consumption, we observed that foods containing large amounts of fat from all sources increased risk of pancreatic cancer in men [odds ratio (OR), 3.41; 95% CI, 1.59-7.29]. Further division of fat by source of food showed that high intake of bacon and sausages (OR for upper tertile, 2.77; 95% CI, 1.34-5.72) as well as large intakes of fatty foods other than meat or dairy products (OR for upper tertile, 2.80; 95% CI, 1.33-5.89) increased risk of pancreatic cancer in men; high levels of intake of red meat, chicken, fish, and dairy foods did not increase risk of pancreatic cancer in either men or women. In women, fat from nonmeat and nondairy sources also increased risk of pancreatic cancer (OR for upper tertile, 3.44; 95% CI, 1.35-8.78). Although no protective effect was observed among men who consumed large amounts of fruits, vegetables, or high fiber foods, we did observe a protective effect in women for these foods (OR for upper tertile of fruit consumption, 0.37; 95% CI, 0.18-0.81; OR for upper tertile of vegetable consumption, 0.32; 95% CI, 0.13-0.74; and OR for upper tertile of fiber consumption, 0.28; 95% CI, 0.12-0.67). Findings from this study support the hypothesis that diets high in fat contribute to the development of pancreatic cancer.(ABSTRACT TRUNCATED AT 250 WORDS)
Adenocarcinoma↗
Effect of pharmaceutical formulation for diltiazem on health care expenditures for hypertension.
A 1-year retrospective analysis was undertaken to discern the economic utility of providing prescription coverage for the sustained-release (SR) formulation of diltiazem, a calcium-channel antagonist, under the state of South Carolina's Medicaid program. Data for this analysis were derived from the state of South Carolina's Medicaid computer archive. The study population consisted of 347 ambulatory beneficiaries diagnosed with hypertension for whom either the SR or immediate-release (IR) formulation of diltiazem was prescribed. Multivariate regression analysis was used to discern the incremental influence of selected demographic characteristics, use of medical services prior to diagnosis for hypertension, and prescribed formulation of diltiazem on health care expenditures 1-year postdiagnosis. Patients for whom the SR formulation of diltiazem was prescribed achieved a significant (P < or = 0.05) increase in the medication possession ratio, an index of compliance (SR, 0.63 +/- 0.17) relative to patients for whom the IR formulation was prescribed (IR, 0.44 +/- 0.13). Results indicate that receipt of diltiazem in an SR formulation was associated with a significant decrease in aggregate health care expenditures over the 1-year study period ($258.80, P < or = 0.05). Receipt of the SR formulation was associated with an increase in expenditures for antihypertensive therapy ($109.26, P < or = 0.05), and a decrease in financial commitments for physician ($128.70, P < or = 0.05), hospital ($211.84, P < or = 0.05), and laboratory ($27.52, NS) services. At the managerial and policy levels, these data argue for an increased use of therapeutic alternatives that facilitate a reduction in the patient's daily dosing schedule for antihypertensive therapy.
Aged↗