Suehs Brandon T, Louder Anthony, Udall Margarita, Cappelleri Joseph C, Joshi Ashish V, Patel Nick C
Competitive Health Analytics Inc., Louisville, Kentucky, U.S.A.
Pain Pract. 2014 Jun;14(5):419-26. doi: 10.1111/papr.12073. Epub 2013 May 23.
Managed healthcare organizations often utilize formulary management strategies such as prior authorization and step therapy to guide appropriate medication use and to control medication expenditures. The objective of this study was to examine clinical and economic outcomes associated with implementation of a pregabalin step therapy (ST) policy among Medicare Advantage Prescription Drug (MAPD) members.
Pharmacy and medical claims data from Humana (restricted cohort; ST policy implemented 01/01/2009) and Thomson Reuters MarketScan(®) (unrestricted cohort) were analyzed for MAPD members aged 65 to 89 years receiving treatment for painful diabetic peripheral neuropathy (pDPN), postherpetic neuralgia (PHN) or fibromyalgia (FM). Difference-in-differences (DID) was used to examine year-over-year changes in disease-related and all-cause utilization and costs. Regression analyses examined medication utilization and healthcare expenditures after controlling for between-group compositional differences.
We identified 13,911 members in the restricted cohort and matched to members from unrestricted health plans. FM (51.0%) and pDPN (41.8%) were the most common diagnoses. Members in the unrestricted cohort were older and had a greater level of comorbidity than members in the restricted cohort. The restricted cohort demonstrated greater year-over-year decrease in pregabalin utilization and increase in year-over-year gabapentin utilization compared with the unrestricted cohort. ST restriction was associated with an increase in disease-related pharmacy costs and a decrease in total medical costs for the restricted cohort compared with the unrestricted cohort. There was no difference between cohorts in total healthcare cost.
After controlling for differences in age and comorbidity burden between the groups, implementation of a pregabalin ST restriction was associated with increased disease-related pharmacy costs and decreased total medical costs; however, there was no net difference in total healthcare cost or total pharmacy cost.
管理式医疗组织经常采用诸如预先授权和阶梯治疗等处方集管理策略，以指导合理用药并控制药物支出。本研究的目的是检验在医疗保险优势处方药（MAPD）成员中实施普瑞巴林阶梯治疗（ST）政策相关的临床和经济结果。
对来自Humana（受限队列；2009年1月1日实施ST政策）和汤森路透MarketScan®（非受限队列）的药房和医疗理赔数据进行分析，对象为年龄在65至89岁之间接受疼痛性糖尿病周围神经病变（pDPN）、带状疱疹后神经痛（PHN）或纤维肌痛（FM）治疗的MAPD成员。采用差异-in-差异（DID）方法检验疾病相关和全因利用及成本的逐年变化。回归分析在控制组间构成差异后检验药物利用和医疗保健支出情况。
我们在受限队列中识别出13,911名成员，并与非受限健康计划的成员进行匹配。FM（51.0%）和pDPN（41.8%）是最常见的诊断。非受限队列中的成员比受限队列中的成员年龄更大且合并症水平更高。与非受限队列相比，受限队列中普瑞巴林的利用逐年下降幅度更大，加巴喷丁的利用逐年增加幅度更大。与非受限队列相比，ST限制与受限队列中疾病相关药房成本的增加和总医疗成本的降低相关。两组之间的总医疗保健成本没有差异。
在控制了两组之间年龄和合并症负担的差异后，普瑞巴林ST限制的实施与疾病相关药房成本的增加和总医疗成本的降低相关；然而，总医疗保健成本或总药房成本没有净差异。
