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Open access to innovative drugs: treatment substitutions or treatment expansion?

McCombs JS, Mulani P, Gibson PJ - Health Care Financ Rev (2004)

Bottom Line: Persistence with initial therapy declined, but cost outcomes improved due primarily to reduced nursing home use.Racial disparities were also reversed.Program administrators must use caution when evaluating the impact of unrestricted access on drug therapy outcomes and treatment costs given the changes in the characteristics of patients seeking treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Pharmaceutical Economics and Policy School of Pharmacy, University of Southern California, USA. jmccombs@usc.edu

ABSTRACT
Granting open access to new antipsychotic medications by the California Medicaid Program fostered the desired substitution of second-generation medications for conventional antipsychotics. However, open access also generated an immediate but temporary influx of previously treated patients, many with a recent institutionalization, who restarted drug therapy using the new antipsychotics. Persistence with initial therapy declined, but cost outcomes improved due primarily to reduced nursing home use. Racial disparities were also reversed. Program administrators must use caution when evaluating the impact of unrestricted access on drug therapy outcomes and treatment costs given the changes in the characteristics of patients seeking treatment.

Show MeSH
Episodes of Antipsychotic Drug Therapy Initiated per Month by Type of Drug Used as Initial Therapy
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Related In: Results  -  Collection


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f2-hcfr-25-3-035: Episodes of Antipsychotic Drug Therapy Initiated per Month by Type of Drug Used as Initial Therapy

Mentions: Figure 2 presents time trend data for olanzapine, risperidone, quetiapine, and typical antipsychotic medications. Open access resulted in an immediate increase in the use of olanzapine and risperidone, while quetiapine's availability coincided with the Medi-Cal formulary expansion and its use grew steadily thereafter. Use of typical antipsychotics dropped significantly, but not enough to offset the increased use of second-generation antipsychotics. Specifically, episode starts per month for typical antipsychotics dropped by 639 (-26 percent) in the transition period, and by 1,388 (-57 percent) under open access. Episode starts per month for the second-generation antipsychotics increased by 2,214 (+237 percent) in the 6-month transition period, but fell back to an increase of 876 (+94 percent) under open access. Thus in the long term, the monthly incidence of treatment initiation decreased by 512 (-15 percent) under open access relative to closed access. This result may simply reflect the selection criteria for the study that required a minimum of 12 months of post-treatment data, a criteria that is less likely to be confirmed as the end of the data period approaches.


Open access to innovative drugs: treatment substitutions or treatment expansion?

McCombs JS, Mulani P, Gibson PJ - Health Care Financ Rev (2004)

Episodes of Antipsychotic Drug Therapy Initiated per Month by Type of Drug Used as Initial Therapy
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4194862&req=5

f2-hcfr-25-3-035: Episodes of Antipsychotic Drug Therapy Initiated per Month by Type of Drug Used as Initial Therapy
Mentions: Figure 2 presents time trend data for olanzapine, risperidone, quetiapine, and typical antipsychotic medications. Open access resulted in an immediate increase in the use of olanzapine and risperidone, while quetiapine's availability coincided with the Medi-Cal formulary expansion and its use grew steadily thereafter. Use of typical antipsychotics dropped significantly, but not enough to offset the increased use of second-generation antipsychotics. Specifically, episode starts per month for typical antipsychotics dropped by 639 (-26 percent) in the transition period, and by 1,388 (-57 percent) under open access. Episode starts per month for the second-generation antipsychotics increased by 2,214 (+237 percent) in the 6-month transition period, but fell back to an increase of 876 (+94 percent) under open access. Thus in the long term, the monthly incidence of treatment initiation decreased by 512 (-15 percent) under open access relative to closed access. This result may simply reflect the selection criteria for the study that required a minimum of 12 months of post-treatment data, a criteria that is less likely to be confirmed as the end of the data period approaches.

Bottom Line: Persistence with initial therapy declined, but cost outcomes improved due primarily to reduced nursing home use.Racial disparities were also reversed.Program administrators must use caution when evaluating the impact of unrestricted access on drug therapy outcomes and treatment costs given the changes in the characteristics of patients seeking treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Pharmaceutical Economics and Policy School of Pharmacy, University of Southern California, USA. jmccombs@usc.edu

ABSTRACT
Granting open access to new antipsychotic medications by the California Medicaid Program fostered the desired substitution of second-generation medications for conventional antipsychotics. However, open access also generated an immediate but temporary influx of previously treated patients, many with a recent institutionalization, who restarted drug therapy using the new antipsychotics. Persistence with initial therapy declined, but cost outcomes improved due primarily to reduced nursing home use. Racial disparities were also reversed. Program administrators must use caution when evaluating the impact of unrestricted access on drug therapy outcomes and treatment costs given the changes in the characteristics of patients seeking treatment.

Show MeSH