PHP100 - UTILIZATIONS AND EXPENDITURES OF TUMOR NECROSIS FACTOR ANTAGONISTS IN MEDICARE PART D: CROSS- SECTIONAL STUDY (2014-2015)

It remains unknown how different glucose tolerance status affects the relationships between dietary intake of different tocopherol isoforms (α-, β-, γ-, and δ-tocopherol) and cellular aging, oxidative stress, and inflammatory markers. The authors conducted a cross-sectional study among 582 Chinese adults with different glucose tolerance status to explore the association between dietary intake of different tocopherol isoforms and cellular aging, oxidative stress, and inflammatory markers. The inverse correlations between non-α-tocopherols and tumor necrosis factor-alpha (TNF-α) varied substantially across different glucose tolerance status, with the strongest observed in prediabetes (r=−0.33 for β-/γ-tocopherol, r=−0.37 for δ-tocopherol, p<0.01), followed by normal glucose tolerance (NGT). While such correlations were abolished in established diabetes. Furthermore, within prediabetes, the strongest inverse correlations between non-α-tocopherols and TNF-α were observed in impaired fasting glucose (IFG) (r=−0.42 for β-/γ-tocopherol, r=−0.55 for δ-tocopherol, p<0.01), while such correlations were significantly attenuated in individuals with impaired glucose tolerance (IGT) and IFG+IGT. And mediation model analysis displayed that TNF-α mediated the protective effect of non-α-tocopherols on leukocyte telomere length and mitochondrial DNA copy number, which was uniquely observed in prediabetes, while such mediation effect was statistically nonsignificant in NGT and established diabetes. In conclusion, our findings indicate that dietary intake of non-α-tocopherols might protect against cellular aging markers mediated by TNF-α in prediabetes. Individuals with prediabetes, especially for IFG, might benefit from increasing dietary intake of non-α-tocopherol in alleviating inflammation and cellular aging, which might provide a new dietary avenue for delaying diabetes onset.

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Opioid prescribing patterns among generalists & oncologists for Medicare Part D beneficiaries from 2013-2017.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.2070 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 2070-2070

Author(s):

Trevor Joseph Royce ◽

Andrew Roberts ◽

Stacie Dusetzina ◽

Ankit Agarwal

Keyword(s):

Medicare Part D ◽

Opioid Therapy ◽

Cross Sectional Study ◽

Prescribing Patterns ◽

Medicare Part ◽

Cross Sectional ◽

Part D ◽

Opioid Prescribing ◽

Poisson Models ◽

Long Acting

2070 Background: In response to the opioid crisis, recent policies aiming to reduce opioid prescribing, misuse, & abuse have generated concern that patients with cancer pain may unintentionally experience reduced access to necessary opioid therapy. It is unknown how opioid prescribing patterns have changed between generalists and oncologists during this era. Methods: We conducted a longitudinal repeated cross-sectional study estimating adjusted annual national trends in opioid prescribing among generalists & oncologists using the Medicare Part D Prescriber Public Use Files 2013-2017. Poisson models estimated annual adjusted predicted mean rates of opioid prescribing-per-1,000 total prescriptions & long-acting opioid prescribing per-1,000 opioid prescriptions. Poisson models estimated adjusted incidence rate ratios (aIRRs) to quantify annual changes in prescribing rates. Results: From 2013-2017 the annual adjusted predicted mean rate of opioid prescriptions per 1,000 total prescriptions decreased from 53.4 to 41.3 among generalists (aIRR = 0.78; p < 0.01) and from 133.2 to 105.9 among oncologists (aIRR = 0.83; p < 0.01). The rate of long-acting opioid fills per 1,000 opioid prescriptions decreased from 96.0 to 87.0 (aIRR = 0.87; p < 0.01) and 235.1 to 222.5 (aIRR = 0.95; p < 0.01) for generalists & oncologists, respectively (Table). Conclusions: We found large declines in overall opioid prescribing rates among generalists (-22%) and oncologists (-17%) from 2013-2017. Long-acting opioid prescribing rates decreased over 2.5-times more among generalists than oncologists. Opioid policy & advocacy have been effective in reducing the extent of opioid prescribing in the Medicare population but how much of the decrease in prescribing by oncologists is ‘appropriate’ versus ‘inappropriate’ deserves further investigation. [Table: see text]

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Projected spending for brand-name drugs in English primary care given US prices: a cross-sectional study

Journal of the Royal Society of Medicine ◽

10.1177/0141076820918238 ◽

2020 ◽

Vol 113 (9) ◽

pp. 350-359

Author(s):

Michael Liu ◽

Brian MacKenna ◽

William B Feldman ◽

Alex J Walker ◽

Jerry Avorn ◽

...

Keyword(s):

Primary Care ◽

Medicare Part D ◽

Access To Medicines ◽

Cross Sectional Study ◽

Medicare Part ◽

Brand Name ◽

Cross Sectional ◽

Part D ◽

The Us ◽

Brand Name Drugs

Summary Objectives To estimate additional spending if NHS England paid the same prices as US Medicare Part D for the 50 single-source brand-name drugs with the highest expenditure in English primary care in 2018. Design Retrospective analysis of 2018 drug prescribing and spending in the NHS England prescribing data and the Medicare Part D Drug Spending Dashboard and Data. We examined the 50 costliest drugs in English primary care available as brand-name-only in the US and England. We performed cost projections of NHS England spending with US Medicare Part D prices. We estimated average 2018 US rebates as 1 minus the quotient of net divided by gross Medicare Part D spending. Setting England and US Participants NHS England and US Medicare systems Main outcome measures Total spending, prescriptions and claims in NHS England and Medicare Part D. All spending and cost measures were reported in 2018 British pounds. Results NHS England spent £1.39 billion on drugs in the cohort. All drugs were more expensive under US Medicare Part D than NHS England. The US–England price ratios ranged from 1.3 to 9.9 (mean ratio 4.8). Accounting for prescribing volume, if NHS England had paid US Medicare Part D prices after adjusting for estimated US rebates, it would have spent 4.6 times as much in 2018 on drugs in the cohort (£6.42 billion). Conclusions Spending by NHS England would be substantially higher if it paid US Medicare Part D prices. This could result in decreased access to medicines and other health services.

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