Stacy Jane, Shaw Elizabeth, Arledge Michele D, Howell-Smith Donna
Humana Inc, Corporate Pharmacy Management, St, Louisville, KY 40202, USA.
J Manag Care Pharm. 2003 Jul-Aug;9(4):327-34. doi: 10.18553/jmcp.2003.9.4.327.
To determine from a health plan perspective the cost-effectiveness of cyclooxygenase-2 (COX-2) specific inhibitors, with and without a prior-authorization (PA) process.
A modeling exercise was employed, based on prescription drug claims for a managed care organization with 3.8 million health maintenance organization (HMO) and preferred provider organization (PPO) members. Drug claims revealed 96154 members (2.9% of the 3.3 million members with a pharmacy benefit) who received either one or more prescriptions for a COX-2 drug or a nonspecific nonsteroidal anti-inflammatory drug (NSAID). These patients were stratified into 2 groups for further analysis, those having a concurrent proton pump inhibitor (PPI) and those without a concurrent PPI. Decision analysis was used to estimate the cost-effectiveness of COX-2 therapy. Actual health plan drug claims data were used to determine utilization and prescribing patterns of nonspecific NSAIDs, COX-2 specific inhibitors, and PPIs. Results from the literature from 8 clinical trials were employed to determine the probability of a serious gastrointestinal (GI) event. Cost-effectiveness analysis (CEA) was used to determine the cost of each therapy, including the predicted cost to treat a serious GI event in a drug benefit design with PA versus a benefit design without PA.
Cost-effectiveness analysis (CEA) showed that the cost per success no serious GI event) for Cox-2 specific inhibitors with PA was US dollars 278 versus US dollars 422 without PA.
The one-year model predicted that costs associated with an increase in COX-2 utilization after removal of PA would exceed the costs to administer PA and treat NSAID-related serious GI events in the managed care population. Based upon this CEA, PA appears to be an effective tool to manage COX-2 pharmacy costs. Further examination of the medical claims would be useful to validate the assumed GI event rates with or without PA and to further demonstrate more definitively the value of a PA program for COX-2 drugs.
从健康计划的角度确定环氧化酶-2（COX-2）特异性抑制剂在有和没有事先授权（PA）流程情况下的成本效益。
采用建模方法，基于一家拥有380万健康维护组织（HMO）和优选提供者组织（PPO）成员的管理式医疗组织的处方药索赔数据。药物索赔显示，96154名成员（在拥有药房福利的330万成员中占2.9%）接受了一种或多种COX-2药物或非特异性非甾体抗炎药（NSAID）的处方。这些患者被分为两组进行进一步分析，即同时使用质子泵抑制剂（PPI）的患者和未同时使用PPI的患者。使用决策分析来估计COX-2治疗的成本效益。实际健康计划药物索赔数据用于确定非特异性NSAIDs、COX-2特异性抑制剂和PPIs的使用情况和处方模式。来自8项临床试验的文献结果用于确定严重胃肠道（GI）事件的发生概率。成本效益分析（CEA）用于确定每种治疗的成本，包括在有PA的药物福利设计与无PA的福利设计中治疗严重GI事件的预测成本。
成本效益分析（CEA）表明，有PA的COX-2特异性抑制剂每成功避免一次严重GI事件的成本为278美元，无PA时为422美元。
一年模型预测，取消PA后COX-2使用增加相关的成本将超过在管理式医疗人群中实施PA和治疗NSAID相关严重GI事件的成本。基于此CEA，PA似乎是管理COX-2药房成本的有效工具。进一步检查医疗索赔将有助于验证有无PA时假定的GI事件发生率，并更明确地证明COX-2药物PA计划的价值。
