Estimated cost savings associated with the use of valsartan in heart failure in a large US health plan

Objective: Previous studies suggest that the complexity of a dosing regimen may affect medication adherence. We examined the association between dosing frequency and adherence for 2 concomitant medications commonly prescribed to patients with non-valvular atrial fibrillation (NVAF), metoprolol (MET) and carvedilol (CAR). Methods: A retrospective claims study from a large US commercial and Medicare Advantage health plan analyzed data of adults ( > 18 years) with 1 inpatient or 2 outpatient claims for NVAF between 1/1/2008 - 12/31/2010. Patients with > 2 pharmacy claims for MET or CAR were analyzed separately. Within MET and CAR samples, once-daily (QD) and twice-daily (BID) cohorts were defined by the dosing frequency on pharmacy claims. The index date was set as the date of the first MET or CAR claim. Patients were continuously enrolled in the health plan for 1 year before (pre-index) and 1 year after (post-index) the index date. MET patients were required to have > 1 pre-index claim for acute myocardial infarction, angina, heart failure, or hypertension; CAR patients were required to have ≥1 claim for heart failure or hypertension. Patients using both QD and BID formulations of the index medication were excluded. Adherence to the index medication was assessed by the proportion of days covered (PDC) during the post-index period. PDC between QD and BID patients was compared using logistic regression to adjust for demographic and pre-index clinical characteristics. The proportion of QD and BID patients who discontinued the index medication (defined by a gap > 30 days) during the post-index period was also compared. Results: The analysis included 11,621 MET patients (QD: 6,084; BID: 5,537) and 4,393 CAR patients (QD: 203; BID: 4,190). Mean (SD) age was 70 (12) years for MET and CAR patients; 59% of MET and 69% of CAR patients were male. Compared to patients with BID dosing, patients with QD dosing were on average younger, more likely to be male, and had a lower comorbidity burden. Fewer patients discontinued MET or CAR with QD than BID dosing (MET: 38% vs. 51%, p<0.001; CAR: 39% vs. 48%, p=0.009). The proportion of patients with PDC > 80% was greater for patients with QD than BID dosing (MET: 62% vs. 50%, p< 0.001; CAR: 63% vs. 53%, p=0.004). MET patients with BID dosing were less likely to achieve PDC > 80% than patients with QD dosing (adjusted OR: 0.66; 95% CI: 0.609-0.712). CAR patients with BID dosing were less likely to achieve PDC > 80% than patients with QD dosing (adjusted OR: 0.69; 95% CI: 0.508-0.934). Among MET and CAR patients, age <60 years was associated with lower adherence (p<0.001) while prior use of index medication was associated with higher adherence (p≤0.001) to the index medication. Conclusion: Medication adherence to MET and CAR was higher with QD than BID dosing. Quality initiatives that reduce the dosing frequency of treatment regimens may improve medication adherence among NVAF patients.

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Abstract 2095: Health Policy: Can an Open Access Model for Intravenous Diuretics in an Outpatient Heart Failure Disease Management Program Reduce Hospital Costs?

Circulation ◽

10.1161/circ.118.suppl_18.s_668-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Dylan L Steen ◽

Valerie Reed ◽

Gwendolyn Roxas ◽

Maria Fonseca ◽

Barbara Lopez ◽

...

Keyword(s):

Heart Failure ◽

Weight Gain ◽

Open Access ◽

Disease Management ◽

Disease Management Program ◽

Hospital Costs ◽

Cost Savings ◽

Management Program ◽

Inpatient Cost ◽

Heart Failure Disease Management

Background: Heart failure (HF) is the most frequent discharge diagnosis for patients older than 65 and one of the most expensive diseases to treat for CMS. Patients with early symptoms of decompensated HF may need access to IV diuretics when oral medications used in a sliding scale dosage are no longer effective. Indigent patients without access to a private physician are at particular risk of having to use the emergency room (ER) for this reason. This model results in more costs and potential admissions. We sought to reduce ER use and improve quality of care and service to indigent patients followed in a Heart Failure Disease Management Program (HFDMP). Methods: Grant funding was procured to provide free furosemide IVP, potassium and metolazone for patients enrolled in a HFDMP at Jackson Memorial Hospital. The HFDM program consist of intense patient education using DVD’s in both English and Spanish, written material, log books for weight, activity, blood pressure and diuretic use. Patients are instructed to weight daily and add an additional oral dose of furosemide at home for weight gain of greater than 2 pounds. For weight gain of greater than 5 pounds unresponsive to oral therapy, patients were given access to the clinic without an appointment for “walk-in” IVP furosemide, potassium and metolazone. Results: 173 new patients were enrolled into program in 3 months (10/07 through 12/31/07). Of these, 115 visits for IVP furosemide were recorded from 54 patients. 16 patients used it multiple times (range 2–11). Average ER cost for all CHF patient seen and discharged after diuresis at JMH is $25,692. Therefore, an estimated cost savings of 115 avoidable ER visits is $2,954,586. In the last three quarters of 2007, of all CHF patients seen in the ER, 96.6% are admitted. The average inpatient cost for a primary diagnosis of CHF was $26,404.05 (LOS 5.25 days). The average for a CHF patient seen and discharged from the ER was $5,295 (LOS <48hrs). All monetary values are Billed Charges. Conclusion: An open access IVP furosemide program is cost effective alternative to ER and inpatient treatment for CHF patients requiring diuresis.

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Abstract 18: Patient-administered Home Inotrope Therapy: A Proof of Concept

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.13.suppl_1.18 ◽

2020 ◽

Vol 13 (Suppl_1) ◽

Author(s):

Wally A Omar ◽

Chris Mathew ◽

Kavita Bhavan ◽

Sandeep R Das ◽

Jose A Joglar

Keyword(s):

Heart Failure ◽

Infusion Pump ◽

Cost Savings ◽

Safety Net ◽

Therapy Program ◽

Advanced Therapies ◽

Safety Net Hospital ◽

End Stage ◽

The Cost ◽

To Receive

Background: Palliative use of continuous IV inotrope therapy has shown to improve quality of life and reduce hospital readmissions for patients with end-stage heart failure (HF) who are otherwise ineligible to receive advanced therapies. Administration of home inotrope therapy generally requires a hospice or home-health agency, placing this option out of reach for patients who lack funding. As such, underinsured patients are relegated to the difficult choice of either remaining in the hospital to receive IV inotropes, or going home without the therapy for as long as their symptoms allow. To address this issue at our large county safety-net hospital, we developed and implemented a patient self-administered home inotrope therapy program. Methods: A multidisciplinary team of physicians, pharmacists, nurses, and social workers was assembled to pilot the program. Eligible patients were provided with a peripherally inserted central venous catheter (PICC) and a portable infusion pump. They were then instructed on proper use of the pump, medication administration, medication bag changes, and IV line care using a nursing teach-back technique. After proper understanding was demonstrated, patients were discharged home with weekly follow up in heart failure clinic for PICC-care and medication exchanges. Results: During the initial 12 months of the program, 5 patients were deemed eligible for enrollment. Total hospitalized days for these patients was 277 (mean = 55.4 days) in the one year prior to enrollment and 12 (mean = 2.4 days) while enrolled for a cumulative period of 288 days (Figure 1). One patient was able to secure funding for advanced therapies, two patients died while enrolled, and two patients are currently enrolled and alive. Discussion: A self-administered home IV inotrope therapy program is a feasible alternative for palliation in unfunded patients with end-stage HF who are otherwise not candidates for advanced therapies, allowing for more days at home in the end of life. Thus far, the cost impact of the program has been mitigated by the cost savings for inpatient hospitalizations. Studies to assess patient-centered outcomes, and overall cost savings are ongoing.

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ePrescribing: Reducing Costs through In-Class Therapeutic Interchange

Applied Clinical Informatics ◽

10.4338/aci-2016-09-ra-0160 ◽

2016 ◽

Vol 07 (04) ◽

pp. 1168-1181 ◽

Cited By ~ 3

Author(s):

Shane Stenner ◽

Rohini Chakravarthy ◽

Kevin Johnson ◽

William Miller ◽

Julie Olson ◽

...

Keyword(s):

Health Plan ◽

Proton Pump ◽

Serotonin Receptor ◽

Cost Savings ◽

Employee Health ◽

Prescription Data ◽

Therapeutic Interchange ◽

Reducing Costs ◽

Serotonin Receptor Agonists ◽

Outpatient Prescriptions

SummaryIntroduction Spending on pharmaceuticals in the US reached $373.9 billion in 2014. Therapeutic interchange offers potential medication cost savings by replacing a prescribed drug for an equally efficacious therapeutic alternative.Methods Hard-stop therapeutic interchange recommendation alerts were developed for four medication classes (HMG-CoA reductase inhibitors, serotonin receptor agonists, intranasal steroid sprays, and proton-pump inhibitors) in an electronic prescription-writing tool for outpatient prescriptions. Using prescription data from January 2012 to June 2015, the Compliance Ratio (CR) was calculated by dividing the number of prescriptions with recommended therapeutic interchange medications by the number of prescriptions with non-recommended medications to measure effectiveness. To explore potential cost savings, prescription data and medication costs were analyzed for the 45,000 Vanderbilt Employee Health Plan members.Results for all medication classes, significant improvements were demonstrated – the CR improved (proton-pump inhibitors 2.8 to 5.32, nasal steroids 2.44 to 8.16, statins 2.06 to 5.51, and serotonin receptor agonists 0.8 to 1.52). Quarterly savings through the four therapeutic interchange interventions combined exceeded $200,000 with an estimated annual savings for the health plan of $800,000, or more than $17 per member.Conclusion A therapeutic interchange clinical decision support tool at the point of prescribing resulted in increased compliance with recommendations for outpatient prescriptions while producing substantial cost savings to the Vanderbilt Employee Health Plan – $17.77 per member per year.Therapeutic interchange rules require rational targeting, appropriate governance, and vigilant content updates.Citation: Stenner SP, Chakravarthy R, Johnson KB, Miller WL, Olson J, Wickizer M, Johnson NN, Ohmer R, Uskavitch DR, Bernard GR, Neal EB, Lehmann CU. eprescribing: reducing costs through in-class therapeutic interchange.

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Budget Impact Analysis of Treating Chemotherapy Patients with Patient-Administered Tbo-Filgrastim, Filgrastim-Sndz, and Filgrastim in the United States

Blood ◽

10.1182/blood.v128.22.4786.4786 ◽

2016 ◽

Vol 128 (22) ◽

pp. 4786-4786

Author(s):

Holly Trautman ◽

Erika Szabo ◽

Francesco Lo-Coco ◽

Elizabeth James ◽

Susan Gabriel ◽

...

Keyword(s):

Febrile Neutropenia ◽

Market Share ◽

Health Plan ◽

Drug Cost ◽

Budget Impact ◽

Cost Savings ◽

Myelosuppressive Chemotherapy ◽

Short Acting ◽

Equity Ownership ◽

Chemotherapy Patients

Abstract Introduction: Neutropenia is a common complication in patients receiving myelosuppressive chemotherapy for nonmyeloid malignancies. Severe and febrile neutropenia are associated with prolonged hospitalization, serious infections and the use of broad-spectrum antibiotics, increased medical costs, and increased mortality. Granulocyte colony-stimulating factors (G-CSFs) are often administered to reduce the incidence, severity, and duration of febrile neutropenia in chemotherapy patients. The present analysis estimated the budget impact of increasing utilization of patient (home)-administered tbo-filgrastim and filgrastim-sndz in patients with nonmyeloid malignancies treated with myelosuppressive chemotherapy from a US payer perspective. Methods: An interactive budget impact model was developed to estimate the changes in drug costs associated with projected increases in the market share of tbo-filgrastim from 5% to 10% and filgrastim-sndz from 10% to 12% (with a corresponding decrease in filgrastim market share from 85% to 78%) for a 1 million-member health plan. Patient self-administration at home was assumed for 20% of patients receiving short-acting G-CSF treatment; all products were purchased through the patient's pharmacy benefit and were assumed to have Tier 3 formulary status with a patient co-pay of $54 per prescription. Base-case data were derived from publicly available resources. The overall plan budget impact was calculated using a 1-year time horizon, along with the difference in per-member per-year (PMPY) cost between the current and future scenarios; one-way sensitivity analyses were conducted. Results: The effective annual plan per-patient drug cost totaled between $16,961 and $27,199, depending on dose and presentation, for tbo-filgrastim, between $16,216 and $26,015 for filgrastim-sndz, and between $19,134 and $30,663 for filgrastim. The estimated overall annual plan cost associated with short-acting G-CSFs was $53,298,217 (PMPY = $53.30) in the current scenario and $52,828,832 (PMPY = $52.82) in the future scenario. Estimated cost savings totaled $469,385 (PMPY = $0.48). The model was most sensitive to changes in the overall proportion of patients self-administering G-CSFs at home and to the wholesale acquisition cost for filgrastim. Conclusions: The effective annual plan per-patient drug cost for tbo-filgrastim and filgrastim-sndz was lower by 11% and 15%, respectively, as compared with filgrastim. The present analysis estimated an annual US health plan cost savings approaching $0.5 million overall or $0.50 PMPY following an increase of market share by approximately 5% for tbo-filgrastim and 2% for filgrastim-sndz. Disclosures Trautman: Teva Pharmaceuticals, Inc.: Consultancy. Szabo:Eli Lilly & Company; Zoetis: Equity Ownership; Teva Pharmaceuticals, Inc.: Employment; Patient Centered Outcomes Research (PCORI): Consultancy. Lo-Coco:Teva, Lundbeck: Honoraria, Speakers Bureau; Teva, Novartis, Baxalta, Pfizer: Consultancy. James:Teva Pharmaceuticals, Inc.: Consultancy. Gabriel:Teva Pharmaceuticals, Inc.: Employment. Pathak:Teva Pharmaceuticals: Employment, Equity Ownership. Tang:Teva Pharmaceuticals, Inc.: Employment.

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Appropriate utilization of cardiac magnetic resonance for the assessment of heart failure and potential associated cost savings

Journal of Magnetic Resonance Imaging ◽

10.1002/jmri.26015 ◽

2018 ◽

Vol 49 (7) ◽

pp. e132-e138

Author(s):

Nishchay Kaushal ◽

Harindra C. Wijeysundera ◽

Kim A. Connelly ◽

Idan Roifman

Keyword(s):

Heart Failure ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Cost Savings

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Cost-effectiveness of noninvasive telemedical interventional management in patients with heart failure: health economic analysis of the TIM-HF2 trial

Clinical Research in Cardiology ◽

10.1007/s00392-021-01980-2 ◽

2021 ◽

Author(s):

Hanna Sydow ◽

Sandra Prescher ◽

Friedrich Koehler ◽

Kerstin Koehler ◽

Marc Dorenkamp ◽

...

Keyword(s):

Heart Failure ◽

Health Care ◽

Health Economic ◽

Usual Care ◽

Usual Care Group ◽

Cost Savings ◽

Care Group ◽

Interventional Management ◽

Patients With Heart Failure ◽

Intervention Costs

Abstract Background Noninvasive remote patient management (RPM) in patients with heart failure (HF) has been shown to reduce the days lost due to unplanned cardiovascular hospital admissions and all-cause mortality in the Telemedical Interventional Management in Heart Failure II trial (TIM-HF2). The health economic implications of these findings are the focus of the present analyses from the payer perspective. Methods and results A total of 1538 participants of the TIM-HF2 randomized controlled trial were assigned to the RPM and Usual Care group. Health claims data were available for 1450 patients (n = 715 RPM group, n = 735 Usual Care group), which represents 94.3% of the original TIM-HF2 patient population, were linked to primary data from the study documentation and evaluated in terms of the health care cost, total cost (accounting for intervention costs), costs per day alive and out of hospital (DAOH), and cost per quality-adjusted life year (QALY). The average health care costs per patient year amounted to € 14,412 (95% CI 13,284–15,539) in the RPM group and € 17,537 (95% CI 16,179–18,894) in the UC group. RPM led to cost savings of € 3125 per patient year (p = 0.001). After including the intervention costs, a cost saving of € 1758 per patient year remained (p = 0.048). Conclusion The additional noninvasive telemedical interventional management in patients with HF was cost-effective compared to standard care alone, since such intervention was associated with overall cost savings and superior clinical effectiveness. Graphical abstract

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P055 MARKOV CHAIN ECONOMIC IMPACT MODEL FOR ANTI-TNF NON-RESPONSE STRATIFICATION OF PATIENTS WITH MODERATE TO SEVERE ULCERATIVE COLITIS

Inflammatory Bowel Diseases ◽

10.1093/ibd/zaa010.033 ◽

2020 ◽

Vol 26 (Supplement_1) ◽

pp. S14-S15

Author(s):

Anna Jeter ◽

Helia Sanchez ◽

Johanna Withers ◽

Viatcheslav Akmaev ◽

Lena Chaihorsky ◽

...

Keyword(s):

Ulcerative Colitis ◽

Precision Medicine ◽

Health Plan ◽

Annual Cost ◽

Budget Impact ◽

Performance Metrics ◽

Cost Savings ◽

Medical Costs ◽

Impact Model ◽

The Cost

Abstract Objective The annual cost of ulcerative colitis (UC) in the US is estimated to be as high as $14.9 billion, of which therapeutics account for up to 45%. The mean annual drug cost per patient with moderate to severe UC is $28,586. However, only 49% of patients achieve endoscopic healing on their first anti-tumor necrosis factor (anti-TNF) therapy and up to half of UC patients on biologics discontinue therapy within 12 months of initiation which leads to high rates of hospitalization and surgery. We performed a health care payer budget impact analysis to assess the influence of a precision medicine RNA-based classifier (PrismUC) that predicts, at baseline, anti-TNF non-response in patients with moderate to severe UC. Methods We developed a 12-month budget impact model for a 1-million-member health plan by analyzing peer-reviewed literature of treatment patterns in commercial and Medicare populations moderate to severe UC patients. Inputs included drug and medical costs, UC prevalence, biologic assignment patterns, therapy response rates, therapy persistence, therapy cycling, endoscopic healing rates, and risk of surgery. Drug and medical costs were obtained from published literature. A Markov model was created to estimate indirect effects of treatment efficacy, timing and cost of disease progression in subjects identified as anti-TNF non-responders (patients who fail to achieve endoscopic healing). Non-responders were assigned either to an alternative first-line therapy (vedolizumab) or to the standard of care (SOC) as determined by clinician judgments and payer formularies. The SOC included cycling patients through various biologics such as anti-TNF, vedolizumab, tofacitinib and ustekinumab. The cost of SOC was compared that of implementing a classifier to stratify patients by primary non-response to anti-TNF. Final cost savings included the cost of drugs, hospitalizations, and surgeries. Results Introducing a classifier that identifies anti-TNF non-responder UC patients to a 1-million-member health plan resulted in annual cost savings ranging from $6.8 to $9.6 million total (Table 1) within a 12-month period with and $9.0 to $12.7 thousand per patient (Table 2), depending on classifier performance metrics. Conclusion The PrismUC precision medicine classifier test that identifies non-responders to anti-TNF therapy will provide significant economic savings to payers by decreasing expenditures on unnecessary drugs and shortening times to endoscopic healing. These savings provide an economic incentive for payers to proactively engage with diagnostics manufacturers and encourage development of such tools to improve care management. A subsequent classifier that predicts response to therapies with alternative mechanisms of action is in development and expected to yield even higher cost savings.

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