scholarly journals Managing Pharmaceutical Expenditures: Estimating the Effect of Internal Reference Pricing for Three Pharmacological Categories

2020 ◽  
Vol 1 (2) ◽  
pp. 76-81
Author(s):  
Maryam Rangchian ◽  
Zeinab Bagheri ◽  
Najmeh Moradi
Keyword(s):  
Reference Price ◽  
Reference Group ◽  
Pharmaceutical Expenditure ◽  
Routine Data ◽  
Pharmaceutical Pricing ◽  
Internal Reference ◽  
Reference Pricing ◽  
Hypothetical Scenario ◽  
Minimum Price ◽  
The Mean

Background: Internal reference pricing (IRP) is one of the pharmaceutical pricing approaches, which is widely favored by health policymakers in different countries as a cost-containment tool for managing medicine expenditure. Evidence related to the implementation of this method confirms its usefulness in reducing pharmaceutical costs. Accordingly, the purpose of this study was to calculate potential changes in pharmaceutical expenditure using the IRP method for products belonging to three pharmaceutical categories in the pharmaceutical system of Iran. Methods: This routine data study assessed the potential effect of IRP in three pharmaceutical categories including statins, non-steroidal anti-inflammatory drugs, and proton pump inhibitors (PPIs). Two scenarios for reference groups (levels 4 and 5 of the ATC code) and four scenarios for the reference price (i.e., the minimum, median, mean, and the mean of three minimum prices in the reference group) were considered in this regard, and the price and sales data source was the report published by the Iranian Food and Drug Administration. Then, cost changes were calculated with each hypothetical scenario. It was assumed that other intervening factors remain unchanged, including consumers and prescribers’ behavior. Results: Based on the results, the two largest potential saving effects belonged to the minimum price scenario and the mean of the scenario of the three minimum prices, respectively. However, the results showed that the consequence of using a price scenario other than the minimum price as the reference price is highly related to the details of the distribution of prices in the related reference group. In addition, appropriate decisions regarding outlier products (e.g., imported products) might have extremely important effects on the result, especially for the mean price scenario. The minimum price scenario concomitant with a premium for superior products can also be considered, but part of it is outside the scope of this study and requires independent research. Conclusion: Thus if an appropriate scenario is selected for the reference price and group, the IRP method has the potential to reduce the costs of medicines. Therefore, pharmaceutical policymakers must pay enough attention to the details of planning this system and the needed procedure for updating the details of this system.

scholarly journals Maternal obesity influences birth weight more than gestational diabetes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Eman M Alfadhli
Keyword(s):  
Birth Weight ◽  
Gestational Diabetes ◽  
Pregnancy Outcomes ◽  
Maternal Obesity ◽  
Reference Group ◽  
Adverse Pregnancy Outcomes ◽  
Antenatal Visit ◽  
Oral Glucose ◽  
The Mean ◽  
Adverse Pregnancy

Abstract Background Maternal obesity and gestational diabetes (GDM) are commonly encountered during pregnancy. Both conditions are independently associated with unfavorable pregnancy consequences. The objective of this study was to compare the effects of obesity and GDM on birth weight, macrosomia, and other adverse pregnancy outcomes. Methods This cohort study involved 531 women with a singleton pregnancy attending the Maternity and Children’s Hospital, Medina, Saudi Arabia, between June 2014 and June 2015. Participants underwent a 75-g oral glucose tolerance test between 24 and 28 weeks. The International Association of Diabetes and Pregnancy Study Groups criteria were used for GDM diagnosis. BMI was assessed at the first antenatal visit, and obesity was defined as a BMI ≥30.0 kg/m2. All women were followed up until delivery. Women were divided into 4 groups: non-GDM nonobese (reference group), GDM nonobese, obese non-GDM, and obese GDM. Clinical characteristics and adverse pregnancy outcomes were compared. Results The mean age and BMI of the participants were 30.5 years and 29.3 kg/m2, respectively. GDM was diagnosed in 50.2% of the participants, and obesity was diagnosed in 47.8% of the participants. Obese women with GDM were the oldest and heaviest among all women. The mean birth weight increased in order among the four groups; it was highest in the infants in the obese GDM group, followed by those in the obese non-GDM, GDM nonobese and reference groups. Obesity and GDM alone or in combination were associated with higher rates of macrosomia and cesarean deliveries than the reference group. Neonatal intensive care unit (NICU) admission was higher in infants in the GDM nonobese and obese GDM groups. The frequency of low Apgar score was significantly higher in infants in the obese GDM group than in infants in the reference group. Conclusions Maternal obesity seems to influence birth weight more than GDM, while GDM is associated with a greater risk of admission to the NICU. The combination of both conditions is associated with the greatest risk of adverse pregnancy outcomes.

Reference Price and Its Asymmetric Effects on Price Evaluations: The Moderating Role of Gender

2017 ◽  
Vol 59 (2) ◽  
pp. 189-194 ◽  
Author(s):  
Choongbeom Choi ◽  
Sung Jun Joe ◽  
Anna S. Mattila
Keyword(s):  
Reference Price ◽  
Internal Reference ◽  
External Reference ◽  
Internal Reference Price ◽  
Scant Attention ◽  
Managerial Implications ◽  
Prior Literature ◽  
External Reference Price ◽  
Promotional Strategies ◽  
The Impact

Empirical research shows that customers form price evaluations by comparing the actual price with a reference price. The relative use of an internal reference price (IRP) versus an external reference price (ERP) is an important issue in the lodging industry due to the popularity of price-comparison–based advertising. Although prior literature shows that demographic factors influence the relative use of IRP and ERP, the impact of gender on the relationship between reference prices and price evaluations has received scant attention in both hospitality and marketing contexts. Drawing on the agency-communal theory, the current research examines the effect of gender on the use of IRP and ERP in price evaluations. The findings indicate that males are more susceptible to IRP than to ERP, whereas females are only influenced by ERP. Relevant managerial implications are drawn in terms of pricing and promotional strategies.

Magnesium, Total Calcium, Phosphorus, Copper, and Zinc in Plasma and Erythrocytes of Venous Cord Blood from Infants of Diabetic Mothers: Comparison with a Reference Group by Logistic Discriminant Analysis

1992 ◽  
Vol 38 (10) ◽  
pp. 2002-2007 ◽  
Author(s):  
M Speich ◽  
A Murat ◽  
J L Auget ◽  
B Bousquet ◽  
P Arnaud
Keyword(s):  
Cord Blood ◽  
Gestational Age ◽  
Comparison Group ◽  
Reference Group ◽  
Total Calcium ◽  
Infants Of Diabetic Mothers ◽  
Calcium Phosphorus ◽  
The Mean ◽  
Diabetic Mothers ◽  
Apparently Healthy

Abstract Concentrations of magnesium (Mg), total calcium (Ca), phosphorus (P), copper (Cu), and zinc (Zn) were investigated in plasma (Pl) and erythrocytes (Erc) of venous cord blood of 44 infants of diabetic mothers (IDMs). These same concentrations plus total glycohemoglobin and fructosamine were determined at delivery in a subset of 15 mothers of these infants. Mineral results for IDMs were compared with those for 66 apparently healthy newborns. The duration of gestation in the two groups was significantly different (P < 0.001). After adjustment for gestational age, the mean (+/- SD) differences between groups were significant for birth weight, head circumference, Erc-Mg (1.71 +/- 0.17 for IDMs vs 1.76 +/- 0.15 mmol/L for control subjects), Pl-Ca (1.96 +/- 0.32 vs 2.48 +/- 0.22 mmol/L), Pl-P (1.99 +/- 0.40 vs 1.57 +/- 0.25 mmol/L), and Erc-Cu (10.9 +/- 2.41 vs 12.9 +/- 3.00 mumol/L), but not for Erc-Zn (33.0 +/- 18.3 vs 40.4 +/- 13.6 mumol/L). The variable that best discriminated between the two infant groups after adjustment for gestational age was Pl-Ca. In the 15 mothers, Pl-Mg (0.67 +/- 0.07 mmol/L) and Pl-Ca (1.66 +/- 0.21 mmol/L) concentrations were low, Pl-Zn (9.81 +/- 3.40 mumol/L) was normal, and Pl-Cu (33.5 +/- 10.7 mumol/L) was above normal. Correlations between total glycohemoglobin and mineral values of the mothers or paired IDM mineral values were not significant. The concentration of Pl-Ca was positively correlated with Erc-Cu (P < 0.001) and Pl-Cu (P < 0.05) in the comparison group newborns but not in the IDMs.

Pharmaceutical Prices

2018 ◽  
Author(s):  
Stuart O. Schweitzer ◽  
Z. John Lu
Keyword(s):  
United States ◽  
Product Quality ◽  
Pharmaceutical Expenditure ◽  
Healthcare Spending ◽  
The United States ◽  
Detailed Examination ◽  
Pharmaceutical Pricing ◽  
The Difference ◽  
The Impact ◽  
Pharmaceutical Prices

This chapter provides a detailed examination of pharmaceutical pricing strategies in the United States. It points out that pharmaceutical expenditure as a share of total healthcare spending has historically been quite low in comparison to that of hospitalization and physician services. It identifies several common measures of pharmaceutical prices, and highlights the difference in conclusions reached based on different measures. It offers a critical review of several models used to explain pharmaceutical price behavior, which are grouped into three major categories: market structure models, R&D cost-based models, and product quality or value based models. The chapter concludes that prices of brand-name drugs in the United States are largely driven by product quality attributes, not cost of R&D. Lastly, the chapter examines the impact of generic entry on price.

Air Embolism During TEVAR: Liquid Perfluorocarbon Absorbs Carbon Dioxide in a Combined Flushing Technique and Decreases the Amount of Gas Released From Thoracic Stent-Grafts During Deployment in an Experimental Setting

2018 ◽  
Vol 26 (1) ◽  
pp. 76-80 ◽  
Author(s):  
Fiona Rohlffs ◽  
Constantin Trepte ◽  
Krassi Ivancev ◽  
Nikolaos Tsilimparis ◽  
Vladimir Makaloski ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Reference Group ◽  
Test Group ◽  
Air Embolism ◽  
Cerebral Injury ◽  
Stent Grafts ◽  
Average Amount ◽  
The Mean ◽  
Instructions For Use ◽  
Small Bubbles

Purpose:To investigate the influence of flushing thoracic stent-grafts with carbon dioxide and perfluorocarbon on the amount of gas released during stent-graft deployment in thoracic endovascular aortic repair (TEVAR). Materials and Methods: Ten TX2 ProForm thoracic stent-grafts were deployed into a water-filled container with a curved plastic pipe and flushed sequentially with carbon dioxide, 20 mL of liquid perfluorocarbon (PFC), and 60 mL of saline. Released gas was measured using a calibrated setup. The volume of released gas was compared with the results of an earlier published reference group, in which identical stent-grafts were flushed with 60 mL saline alone as recommended in the instructions for use. Results: The average amount of gas released in the test group was 0.076 mL, significantly lower (p<0.001) than the mean 0.79 mL of gas released in the reference group. Big bubbles appearing at the tip of the sheath when deployment was started were seen in all grafts of the reference group but in only 2 of the test group stent-grafts. Small bubbles were less frequent in the test group. Conclusion: The amount of gas released from thoracic stent-grafts during deployment can be influenced by different flushing techniques. The use of PFC in addition to the carbon dioxide flushing technique reduces the volume of gas released during deployment of tubular thoracic stent-grafts to a few microliters. This significant effect is presumably based on the high solubility of carbon dioxide in perfluorocarbon and could be a potential future approach to lower the risk of cerebral injury and stroke from air embolism during TEVAR.

Improving fund allocation in Iran Health Insurance Organization by applying internal reference pricing: a policy brief

2019 ◽  
Author(s):  
Nazila Yousefi ◽  
Mahyar Polroudi Moghaddam ◽  
Razie Ahmadi ◽  
Golbarg Ghiasi ◽  
Farzad Peiravian
Keyword(s):  
Health Insurance ◽  
Internal Reference ◽  
Fund Allocation ◽  
Reference Pricing

Effects of rising drug costs on efforts to control overall cost at a large academic cancer center.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 2-2
Author(s):  
Kerin B. Adelson ◽  
Maureen Canavan ◽  
Susanna N. Supalla ◽  
Tannaz Sedghi ◽  
Basit Chaudhry ◽  
...  
Keyword(s):  
Acute Care ◽  
Cost Of Care ◽  
Drug Costs ◽  
Cancer Center ◽  
Historical Period ◽  
Pharmaceutical Pricing ◽  
Total Cost ◽  
The Mean ◽  
Mean Cost ◽  
Post Acute Care

2 Background: Value-based payment programs like the Oncology Care Model (OCM) have focused efforts to reduce costly acute care use through improvements in access and coordination rather than targeting the exponential rise in pharmaceutical pricing. We assessed how participation in OCM affected total cost of cancer care at a large academic cancer center. Methods: Using Medicare claims for Yale-Smilow Cancer Hospital, an NCI-designated cancer center with an academic hub and 10 community practices, we identified episodes for chemotherapy initiated during a historical period (pre-OCM, 2012-2015) and performance period (post-OCM, 2016-2017) following OCM criteria to identify total cost of care. We reported frequency of utilization categories, the mean cost per episode, the proportion of total cost attributed to each utilization category and compared pre- and post-participation periods. Results: There were 8,843 episodes during the historical period and 6,679 episodes during the performance period. The mean total cost per episode increased from $28,645 to $32,666, but this was less than the Medicare-defined expected increase (target price). Between the two periods, the percentage of total episodes decreased for emergency department (ED) use from 36% to 33%, inpatient care from 33% to 29%, and post-acute care from 28% to 25% (p < 0.01). Mean costs of drugs per episode increased by 27% between periods, and from 52% to 58% of total cost of care (p < 0.01). While mean cost per episode for ED, inpatient, and post-acute care remained stable, the mean cost per episode for antineoplastics increased 39% from $10,676 to $14,843. Conclusions: After implementing OCM, we beat the Medicare target largely by decreasing acute care use and stabilizing the cost of hospitalizations and ED; however, actual cost increased largely due to pharmaceutical spending. Because drug costs were the largest proportion of overall cost of care, future value-based models must address the rising cost of pharmaceuticals. [Table: see text]

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