Carlton Rashad, Lunacsek Orsolya, Regan Timothy, Carroll Cathryn A
Assistant Director, Global Health Economics and Outcomes Research, Xcenda, Palm Harbor, FL.
Associate Director, Applied Data Analytics, Xcenda, Palm Harbor, FL.
Am Health Drug Benefits. 2014 Sep;7(6):334-40.
Excessive daytime sleepiness affects nearly 20% of the general population and is associated with many medical conditions, including shift work disorder (SWD), obstructive sleep apnea (OSA), and narcolepsy. Excessive sleepiness imposes a significant clinical, quality-of-life, safety, and economic burden on society.
To compare healthcare costs for patients receiving initial therapy with armodafinil or with modafinil for the treatment of excessive sleepiness associated with OSA, SWD, or narcolepsy.
A retrospective cohort analysis of medical and pharmacy claims was conducted using the IMS LifeLink Health Plan Claims Database. Patients aged ≥18 years who had a pharmacy claim for armodafinil or for modafinil between June 1, 2009, and February 28, 2012, and had 6 months of continuous eligibility before the index prescription date, as well as International Classification of Diseases, Ninth Revision diagnosis for either OSA (327.23), SWD (327.36), or narcolepsy (347.0x) were included in the study. Patients were placed into 1 of 2 treatment cohorts based on their index prescription and followed for 1 month minimum and 34 months maximum. The annualized all-cause costs were calculated by multiplying the average per-month medical and pharmacy costs for each patient by 12 months. The daily average consumption (DACON) for armodafinil or for modafinil was calculated by dividing the total units dispensed of either drug by the prescription days supply.
A total of 5693 patients receiving armodafinil and 9212 patients receiving modafinil were included in this study. A lower DACON was observed for armodafinil (1.04) compared with modafinil (1.47). The postindex mean medical costs were significantly lower for the armodafinil cohort compared with the modafinil cohort after adjusting for baseline differences ($11,363 vs $13,775, respectively; P = .005). The mean monthly drug-specific pharmacy costs were lower for the armodafinil cohort compared with the modafinil cohort ($166 vs $326, respectively; P <.001). In addition, lower total healthcare costs were observed for the armodafinil cohort compared with the modafinil cohort after correcting for baseline differences ($18,309 vs $23,530, respectively; P <.001).
As shown in this analysis, armodafinil may have real-world DACON advantages and may be associated with lower overall healthcare costs compared with modafinil.
日间过度嗜睡影响了近20%的普通人群，并与许多医学病症相关，包括轮班工作障碍（SWD）、阻塞性睡眠呼吸暂停（OSA）和发作性睡病。过度嗜睡给社会带来了重大的临床、生活质量、安全和经济负担。
比较接受阿莫达非尼或莫达非尼初始治疗的患者治疗与OSA、SWD或发作性睡病相关的过度嗜睡的医疗费用。
使用IMS LifeLink健康计划索赔数据库对医疗和药房索赔进行回顾性队列分析。纳入2009年6月1日至2012年2月28日期间有阿莫达非尼或莫达非尼药房索赔、在索引处方日期前有6个月连续资格以及国际疾病分类第九版诊断为OSA（327.23）、SWD（327.36）或发作性睡病（347.0x）的≥18岁患者。根据患者的索引处方将其分为2个治疗队列之一，并随访至少1个月和最长34个月。通过将每位患者每月的平均医疗和药房费用乘以12个月来计算年化全因成本。阿莫达非尼或莫达非尼的日均消耗量（DACON）通过将任一药物的总配药单位数除以处方天数供应量来计算。
本研究共纳入5693例接受阿莫达非尼治疗的患者和9212例接受莫达非尼治疗的患者。与莫达非尼（1.47）相比，阿莫达非尼的DACON较低（1.04）。在调整基线差异后，阿莫达非尼队列的索引后平均医疗费用显著低于莫达非尼队列（分别为11,363美元和13,775美元；P = 0.005）。阿莫达非尼队列的平均每月特定药物药房费用低于莫达非尼队列（分别为166美元和326美元；P < 0.001）。此外，在校正基线差异后，阿莫达非尼队列的总医疗费用低于莫达非尼队列（分别为1,8309美元和23,5,30美元；P < 0.001）。
如本分析所示，与莫达非尼相比，阿莫达非尼可能具有实际的DACON优势，并且可能与较低的总体医疗费用相关。
