Growth of diabetes drug expenditure decomposed—A nationwide analysis

Soppi, Aarni; Heino, P.; Kurko, Terhi; Maljanen, Timo; Saastamoinen, Leena; Aaltonen, Katri

doi:10.1016/j.healthpol.2018.09.008

Cited by 21 publications

(15 citation statements)

References 11 publications

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“…However, according to the findings of our work in an ideal setting, about half of very high risk patients would be candidates for PCSK9 inhibitors according to the new European guidelines. The economic consequences could be important and should be analyzed in the context of the advent of other expensive antidiabetic drugs, such as glucagon-like peptide-1 (GLP-1) receptor agonists or sodium-glucose cotransporter-2 (SGLT2) inhibitors [25,26]. According to the recently published guidelines on diabetes, prediabetes, and cardiovascular disease, patients with high or very high cardiovascular risk with glycated hemoglobin (HbA1c) greater than 7.0% (53 mmol/mol) should receive these drug groups.…”

Section: Discussionmentioning

confidence: 99%

Impact of the 2019 European Guidelines on Diabetes in Clinical Practice: Real and Simulated Analyses of Lipid Goals

Masson

Huerín²,

Lobo

et al. 2020

JCDD

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Background: Recent European guidelines on diabetes, prediabetes, and cardiovascular disease developed for the European Society of Cardiology (ESC) in collaboration with the European Association for the Study of Diabetes (EASD) significantly changed some concepts on risk stratification, lipid goals, and recommendations for the use of lipid-lowering drugs. The objectives of this work were to describe the lipid-lowering treatment prescribed for patients with diabetes and to determine the percentage of patients that achieved the lipid goals recommended by the 2019 ESC/EASD Guidelines on Diabetes in real and simulated scenarios. Methods: A multicenter, cross-sectional study was performed. Subjects >18 years with type 2 diabetes were included. The recommendations of the 2019 ESC/EASD Guidelines were followed. The real and simulated (ideal setting using adequate doses of statins ± ezetimibe) scenarios were analyzed. Results: Overall, 528 patients were included. In total, 62.5% of patients received statins (17.1% high intensity). Most patients were stratified as “very high risk” (54.2%) or “high risk” (43.4%). Only 13.3% achieved the double lipid goal (LDL-C and non-HDL-C goals according to the risk categories). In the simulation analysis, the proportion of subjects that did not reach the therapeutic objective decreased in all risk strata, although a considerable proportion of subjects persisted outside the target. Conclusion: The difficulty of achieving lipid goals in diabetic patients was considerable when applying the new guidelines. The situation would improve if we optimized treatment, but the prescription of new lipid-lowering drugs could be limited by their high cost.

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Section: Discussionmentioning

confidence: 99%

Impact of the 2019 European Guidelines on Diabetes in Clinical Practice: Real and Simulated Analyses of Lipid Goals

Masson

Huerín²,

Lobo

et al. 2020

JCDD

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“…number of recipients, treatment intensity), or both (∆C = ∆P × ∆V), we used standard decomposition methods to determine the major drivers of the expected 5-year spending increases. These methods, used previously to assess changes in outpatient and drug expenditures (26)(27)(28)(29)(30), isolate the impact of each driver (or effect) by estimating the change in spending from the change in one effect, while holding other effects constant. For each biologic DMARD, we considered 1 price effect (specifically, change in price per dose) and 3 volume effects: number of recipients (V a ); number of claims per recipient (V b ), which reflects the duration of treatment; and number of doses per claim (V c ), which reflects the intensity of treatment.…”

Section: Discussionmentioning

confidence: 99%

Decomposition Analysis of Spending and Price Trends for Biologic Antirheumatic Drugs in Medicare and Medicaid

McCormick

Wallace

Sacks

et al. 2020

Arthritis & Rheumatology

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Objective. Billions of public dollars are spent each year on biologic disease-modifying antirheumatic drugs (DMARDs), but the drivers of recent increases in biologic DMARD spending are unclear. This study was undertaken to characterize changes in total spending and unit prices for biologic DMARDs in Medicare and Medicaid programs and quantified the major sources of these spending increases.Methods. We accessed drug spending data from years 2012-2016, covering all Medicare Part B (fee-for-service), Medicare Part D, and Medicaid enrollees. After calculating 5-year changes in total spending and unit prices for each biologic DMARD as well as in aggregate, we performed standard decomposition analyses to isolate 4 sources of spending growth: drug prices, uptake (number of recipients), treatment intensity (mean number of doses per claim), and treatment duration (annual number of claims per recipient), both excluding and including time-varying rebates.Results. From 2012 to 2016, annual spending on public-payer claims for the 10 biologic DMARDs included in this study more than doubled ($3.8 billion to $8.6 billion), with median drug price increases of 51% in Medicare Part D (mean 54%) and 8% in Medicare Part B (mean 21%). With adjustment for general inflation, unit price increases alone accounted for 57% of the 5-year, $3.0 billion spending increase in Part D, while 37% of the spending increase was from increased uptake. Accounting for time-varying rebates, prices were still responsible for 54% of increased spending. Unit prices and spending were lower under Medicaid than under Medicare Part D, though temporal trends and contributors were similar.Conclusion. Postmarket drug price changes alone account for the majority of the recent spending growth in biologic DMARDs. Policy interventions targeting price increases, particularly those under Medicare Part D plans, may help mitigate financial burdens for public payers and biologic DMARD recipients.

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“…O método de Fisher tem sido frequentemente utilizado na mensuração da contribuição de cada indutor na variação do gasto em medicamentos (Morgan, 2002;2005;Morgan, Leopold e Wagner, 2017;Soppi et al, 2018). Mas recomenda-se atenção para o fato de que é razoável utilizá-lo apenas nos casos em que os indutores mudam independentemente um do outro, uma vez que o efeito cruzado é atribuído igualmente entre eles.…”

Section: Texto Paraunclassified

TD 2634 - Indutores do Gasto Direto do Ministério da Saúde em Medicamentos (2010-2019)

Vieira¹

2021

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O objetivo deste texto é analisar a contribuição dos principais indutores do gasto direto do Ministério da Saúde (MS) em medicamentos que integram a lista dos componentes da assistência farmacêutica (AF) no período de 2010 a 2019. Foram utilizados dados de aquisições constantes do Sistema Integrado de Administração de Serviços Gerais (Siasg). Os medicamentos foram categorizados segundo o sistema de classificação ATC/DDD (Anatomical Therapeutic Chemical Classification System/defined daily doses) da Organização Mundial da Saúde (OMS). As unidades físicas de compra dos produtos foram transformadas em número de doses diárias definidas (DDD) para cada fármaco e o preço unitário foi convertido para preço por DDD. Com o suporte do software RStudio versão 1.3.1056 e do pacote estatístico IndexNumR, mensurou-se a contribuição dos principais indutores do gasto em medicamentos: preço, quantidade e resíduo (escolhas terapêuticas). Os resultados mostram grande variação do gasto do MS em medicamentos da lista dos componentes da AF no período de 2010 a 2019, com maior ou menor contribuição de cada indutor principal na oscilação observada. Contudo, chama a atenção a redução do gasto em alguns anos, induzida principalmente pela diminuição da quantidade de medicamentos adquirida em dois anos consecutivos, o que pode resultar em queda da disponibilidade desses produtos no Sistema Único de Saúde (SUS).

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Growth of diabetes drug expenditure decomposed—A nationwide analysis

Cited by 21 publications

References 11 publications

Impact of the 2019 European Guidelines on Diabetes in Clinical Practice: Real and Simulated Analyses of Lipid Goals

Impact of the 2019 European Guidelines on Diabetes in Clinical Practice: Real and Simulated Analyses of Lipid Goals

Decomposition Analysis of Spending and Price Trends for Biologic Antirheumatic Drugs in Medicare and Medicaid

TD 2634 - Indutores do Gasto Direto do Ministério da Saúde em Medicamentos (2010-2019)

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