Pharmacoeconomic Analysis of Heartworm Preventive Compliance and Revenue in Veterinary Practices in the United States

Abstract

Background: Heartworm disease (HWD) is a potentially fatal condition caused by the nematode Dirofilaria immitis. It is endemic in North America, and the American Heartworm Society recommends that owned dogs be on a Food and Drug Administration-approved HWD preventive year-round. The objective of this study was to compare the 12-month HWD preventive purchase compliance rates of injectable moxidectin (ProHeart® 6) and the dose equivalent in monthly HWD preventives and their associated economic value to the veterinary hospital.Methods: This study used retrospective anonymized transactional data of 7,926,392 unique dogs from 3,737 companion animal practices across the US for the period 2014–2017. Compliance was defined using American Heartworm Society guidelines. Comparisons were purchases of a 6-month moxidectin injection or six doses of any monthly HWD or HWD combination preventive product, tracked for the next preventive purchase 5–7 months later. Total revenue, HWD prevention cost, 12-month repurchase compliance, and patient retention were calculated. Data were expressed on an annualized basis. Compliance comparisons were calculated based on proportion analysis with the SAS ProbNorm function (SAS 9.4, Cary, NC), using a two-sided t-test, at the 5% level of significance (P < 0.05).Results: At 51.7%, annual compliance with injectable moxidectin was higher than the dose equivalent in monthly HWD preventives, which was 24.4% (P = 0.0001). Eighty-five percent of patients on injectable moxidectin recorded additional transactions during the first visit (average invoice of $161), compared with only 55% of pet owners who purchased monthly HWD prevention (average invoice $141) or monthly HWD combination (average invoice of $171). The average costs of 6 months of HWD preventives were as follows: injectable moxidectin, $48 (29.7% of the total visit invoice); monthly HWD prevention, $45 (31.0% of the total invoice); and monthly HWD combination, 95 (55.6% of the total visit invoice). Finally, dogs receiving injectable moxidectin had a higher proportion of patients with repeat injections within 12 months between 2014 and 2017, with 68% retention rate after 4 years. In comparison, the six-dose monthly HWD cohort retention rate dropped to 55% by 2017.Conclusions: Dogs receiving injectable moxidectin had higher HWD preventive compliance, generated more practice revenue, and had a higher rate of practice retention compared with monthly HWD products.

Retrospective analyses of heartworm (Dirofilaria immitis) disease and ectoparasite preventive medication compliance in veterinary practices in the USA

“…The second and third limitations do not apply to injectable HW prevention that is restricted to the use by or on the order of a licensed veterinarian [7,8], but cannot be ruled out for MHWP. Despite this, retrospective analyses of transaction data have been used previously to examine purchase compliance with antiparasitics in dogs [6,11,[13][14][15][16].…”

“…We did not include an economic calculation in the first analysis, as the revenue benefits of implementing PH6 and PH12 as a strategy to prevent HW disease have been demonstrated previously in two retrospective analyses of transaction data [6,16]. A pharmacoeconomic analysis evaluated the impact of incorporating PH6 into the practice formulary.…”

“…A pharmacoeconomic analysis evaluated the impact of incorporating PH6 into the practice formulary. Although PH6 was similarly priced to the owner as six doses of MHWP, 85% of patients on injectable moxidectin recorded additional transactions during the first visit (average invoice $161) compared with only 55% of pet owners who purchased MHWP (average invoice $141) [16]. In the other economic study, the implementation of PH12 resulted in 15% growth in preventive revenue compared to 3.9% growth in practices that did not bring on PH12, although the cost of PH12 was equivalent to 12 doses of MHWP [6].…”

The compliance and revenue benefits of ProHeart Vs monthly heartworm disease preventives in the US

“…Compliance amongst monthly heartworm preventive patients did not increase in this study year over year. A similar study based on Australian data found that Single-year compliance with ProHeart SR-12 was 92.8–96.9% vs. 26.9–36.5% for dogs receiving MHWP products and multiple year compliance was 76.7% for ProHeart SR-12 and 24.4% for MHWP medications [ 9 ]. Australia has a lower age of first use for injectable moxidectin (12 weeks), compared to the US, where PH 12 is approved for use in dogs 1 year of age and older.…”

A dirofilariasis mouse model for heartworm preclinical research

“…However, due to concerns of veterinary applications of doxycycline, in companion animals, such as long treatment timeframes, dysbiosis side-effects, and antibiotic stewardship of a human essential medicine, development of short-course, narrow-spectrum anti-Wolbachia heartworm therapeutics without general antibiotic properties, may offer a potential future alternative [13]. ML preventatives, costing typically between $266-329 a year for a pet's treatment in the USA, represent a potential multi-billion dollar global market [14]. Due to emergent spread of Dirofilaria immitis infections, the growing concerns of ML prophylactic failure in USA and the current inadequacies of curative treatments, new therapeutic strategies are being intensively investigated.…”