The Effects of Cost Containment and Price Policies on Pharmaceutical Expenditure in South Korea

Background: Policymakers have proposed and implemented various cost-containment policies for drug prices and quantities to regulate rising pharmaceutical spending. Our study focused on a major change in pricing policy and several incentive schemes for curbing pharmaceutical expenditure growth during the 2010s in Korea. Methods: We constructed the longitudinal dataset from 2008-2017 for 11,849 clinics to track the prescriber behavior before and after the implemented policies. Applying an interrupted time series model, we analyzed changes in trends in overall monthly drug expenditure and antibiotic drug expenditure per prescription for outpatient claims diagnosed with three major diseases before and after the policies’ implementation. Results: Significant price reductions and incentives for more efficient drug prescriptions resulted in an immediate decrease in monthly drug expenditures in clinics. However, we found attenuated effects over the long run. The top-spending clinics showed the highest rate of increase in drug costs. Conclusion: Future policy interventions can maximize their effects by targeting high-spending providers.

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Change in Service Provision Networks: The Case of Animal Welfare Services

State and Local Government Review ◽

10.1177/0160323x211009285 ◽

2021 ◽

pp. 0160323X2110092

Author(s):

Laura A. Reese ◽

Xiaomeng Li

Keyword(s):

Service Provision ◽

Survey Design ◽

Participant Observation ◽

Local Level ◽

Major Change ◽

Network Evolution ◽

Political Factors ◽

Before And After ◽

Organizational Ties ◽

The Impact

This research focuses on change within informal service provision networks, specifically examining the impact that changes within a key organization can have on the larger network. Employing a before and after survey design with a treatment at the midpoint and participant observation, it asks: What is the impact of a major change within one organization on the larger external network? What is the nature of the organizational ties? and, How do political factors exogenous to the network impact the network evolution process? The findings suggest that internal change within a focal actor can have ripple effects throughout the network increasing density. Public service provision at the local level can be enhanced through an increase in partnerships between the public and nonprofit sectors. However, network evolution can be limited by the larger political environment and lack of a coordinating role on the part of local government.

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354 Trends in the Drug-Sparing Effects for Benzodiazepines and Prescription Opioids among Insomnia Patients on Suvorexant in the US

SLEEP ◽

10.1093/sleep/zsab072.353 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A141-A141

Author(s):

Hrishikesh Kale ◽

Rezaul Khandker ◽

Ruchit Shah ◽

Marc Botteman ◽

Weilin Meng ◽

...

Keyword(s):

Interrupted Time Series ◽

Charlson Comorbidity Index Score ◽

Prescription Opioid ◽

Prescription Opioids ◽

Opioid Use ◽

Before And After ◽

Prescription Opioid Use ◽

Incident Cohort ◽

Over Time ◽

Post Period

Abstract Introduction Use of benzodiazepines to treat insomnia has been associated with serious side effects and abuse potential. Insomnia patients are at high risk of opioid abuse and better sleep patterns may help to reduce opioid use. This study examined the trend in the use of benzodiazepines and prescription opioids before and after initiation of suvorexant in insomnia patients. Methods The study analyzed 2015–2019, Optum Clinformatics Data Mart. Insomnia patients, identified using ICD-9/10 codes and prescribed suvorexant were included. The study included incident (newly diagnosed) and prevalent cohorts of insomnia patients. The proportion of patients on benzodiazepines or prescription opioids were calculated for 12 monthly intervals before (pre-period) and after initiation of suvorexant (post-period). Interrupted time series (ITS) analysis was conducted to assess trends for use of benzodiazepine or prescription opioids over time. Results A total of 5,939 patients from the incident insomnia cohort and 18,920 from the prevalent cohort were included. For the incident cohort, mean age was 64.47 (SD: 15.48), 63% were females, 71% had Medicare Advantage coverage, 59% had Charlson comorbidity index score (CCI) ≥ 1, 27% had an anxiety disorder and 16% had substance abuse disorder. Prevalent insomnia cohort was similar but had higher CCI. Results from ITS suggested that at the beginning of the pre-period, 28% of incident insomnia patients used either opioids or benzodiazepines with the rate of use in the pre-period increasing by 0.11% per month. In the post-period, the rate of use decreased by 0.33% per month. About 26% patients used benzodiazepines or opioids at 12-month after suvorexant initiation. In the absence of suvorexant, this proportion would have been 31%. Similar findings were observed for the prevalent insomnia cohort. A larger decrease was observed for opioid use than benzodiazepines. Conclusion The rate of benzodiazepines or prescription opioid use decreased over time after the initiation of suvorexant. Suvorexant has the potential to reduce the use of opioids and benzodiazepines among insomnia patients. Further research is needed to confirm these findings. Support (if any) This study was sponsored by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.

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Changes in the Use of Broad-Spectrum Antibiotics after Cefepime Shortage: a Time Series Analysis

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.05560-11 ◽

2011 ◽

Vol 56 (2) ◽

pp. 989-994 ◽

Cited By ~ 12

Author(s):

C. Plüss-Suard ◽

A. Pannatier ◽

C. Ruffieux ◽

A. Kronenberg ◽

K. Mühlemann ◽

...

Keyword(s):

Time Series ◽

Pseudomonas Aeruginosa ◽

Broad Spectrum ◽

Interrupted Time Series ◽

Antibiotic Policy ◽

Content Type ◽

Broad Spectrum Antibiotics ◽

Before And After ◽

Alternative Antibiotic ◽

The Impact

ABSTRACTThe original cefepime product was withdrawn from the Swiss market in January 2007 and replaced by a generic 10 months later. The goals of the study were to assess the impact of this cefepime shortage on the use and costs of alternative broad-spectrum antibiotics, on antibiotic policy, and on resistance ofPseudomonas aeruginosatoward carbapenems, ceftazidime, and piperacillin-tazobactam. A generalized regression-based interrupted time series model assessed how much the shortage changed the monthly use and costs of cefepime and of selected alternative broad-spectrum antibiotics (ceftazidime, imipenem-cilastatin, meropenem, piperacillin-tazobactam) in 15 Swiss acute care hospitals from January 2005 to December 2008. Resistance ofP. aeruginosawas compared before and after the cefepime shortage. There was a statistically significant increase in the consumption of piperacillin-tazobactam in hospitals with definitive interruption of cefepime supply and of meropenem in hospitals with transient interruption of cefepime supply. Consumption of each alternative antibiotic tended to increase during the cefepime shortage and to decrease when the cefepime generic was released. These shifts were associated with significantly higher overall costs. There was no significant change in hospitals with uninterrupted cefepime supply. The alternative antibiotics for which an increase in consumption showed the strongest association with a progression of resistance were the carbapenems. The use of alternative antibiotics after cefepime withdrawal was associated with a significant increase in piperacillin-tazobactam and meropenem use and in overall costs and with a decrease in susceptibility ofP. aeruginosain hospitals. This warrants caution with regard to shortages and withdrawals of antibiotics.

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The effect of dietary protein on metabolite concentrations during fasting in calves differing genetically in dairy merit

Animal Science ◽

10.1017/s0003356100036771 ◽

1992 ◽

Vol 54 (2) ◽

pp. 175-181 ◽

Cited By ~ 4

Author(s):

J. A. Woolliams ◽

R. S. Nisbet ◽

P. Løvendahl

Keyword(s):

Fatty Acids ◽

Sexual Dimorphism ◽

Dietary Protein ◽

Protein Production ◽

Breeding Value ◽

Genetic Merit ◽

Rate Of Increase ◽

Metabolite Concentrations ◽

Before And After ◽

Effect Of Feeding

AbstractEighty calves of both sexes, 4 months of age, of two lines, differing in genetic merit for fat plus protein production by 70 kg per 305-day lactation, were given one of four diets differing in protein content to give an estimated range of protein intakes from 299 to 530 g/day. After 21 days the calves were fasted for 72 h. Samples of blood were taken before and after feeding in the morning and afternoon prior to fasting, seven further samples were taken throughout the fast and five samples were taken ranging from 0·5 to 7·5 h after food was re-introduced. The samples were analysed for concentrations of urea, free fatty acids (FFA), glucose, triglyceride and f5-hydroxybutyrate.No association between metabolite concentrations and predicted breeding value (PBV) were found at any stage of the trial except for the effect of feeding on FFA concentration, the rate of increase of FFA during the fast and its ultimate concentration. These associations with FFA depended on the sex of the calf and were either absent or less marked in males. The results strengthen the possibility that FFA concentrations during fasting are related to PBV in females, and that sexual dimorphism may explain differing conclusions amongst previous trials.The magnitude of the estimate of coheritability of urea concentration during fasting with PBV, pooled across experiments, is reduced from -0·193 to -0·066 (s.e. 0·037) by inclusion of these results. However, heterogeneity between experiments is evident and remains to be explained. This suggests that urea concentrations are not consistent predictors of genetic merit and cannot be considered to be reliable for use in practice.

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A comparison of global suicide terrorism by region before and after 9/11 terrorist attacks

Journal of Aggression Conflict and Peace Research ◽

10.1108/jacpr-06-2021-0604 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Ahmet Guler ◽

Mustafa Demir

Keyword(s):

Time Series ◽

Interrupted Time Series ◽

Sub Saharan Africa ◽

Terrorist Attacks ◽

Suicide Terrorism ◽

Content Type ◽

The World ◽

Before And After ◽

Sub Saharan ◽

Global Terrorism Database

Purpose This study aims to examine the effect of the 9/11 terrorist attacks on suicide terrorism in different regions of the world and changes in the trends in suicide terrorism according to regions before and after 9/11. Design/methodology/approach Using the data obtained from the Global Terrorism Database from 1981 to 2019, the descriptive statistics were computed first and then, independent samples t-tests were run to compare the monthly mean percentage of suicide-terrorism incidents that occurred in each region between the pre-9/11 and the post-9/11 periods. Finally, to statistically assess the effect of the 9/11 attacks and changes in the trends for the dependent variables over time, monthly interrupted time-series analyzes were conducted. Findings The results of monthly interrupted time series analyzes showed that after the 9/11 attacks, the trends for suicide-terrorism rates decreased significantly in three regions including South Asia, the Middle East and North Africa and Europe, while the trend for suicide-terrorism rates increased significantly in Sub-Saharan Africa. However, no statistically significant changes in the trends in suicide-terrorism rates occurred in three regions including North America, East Asia and Central Asia and Southeast Asia before 9/11, during November 2001 or after 9/11. Originality/value This study indicates the critical importance of the 9/11 terrorist attacks in suicide terrorism and its impact on these events in different regions of the world. The research also provides some recommendations concerning the effectiveness of defensive and offensive counterterrorism policies against suicide terrorism.

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Impact of Legislation on Opioid Prescribing following Hysterectomy and Hysteroscopy in Arizona and Florida

Gynecologic and Obstetric Investigation ◽

10.1159/000519517 ◽

2021 ◽

pp. 1-9

Author(s):

Aakriti R. Carrubba ◽

Amy E. Glasgow ◽

Elizabeth B. Habermann ◽

Amanda P. Stanton ◽

Megan N. Wasson ◽

...

Keyword(s):

Statistical Analysis ◽

Cohort Analysis ◽

Oral Morphine ◽

Interrupted Time Series ◽

Interrupted Time Series Analysis ◽

Opioid Use ◽

Prescribing Practices ◽

Opioid Prescribing ◽

Before And After ◽

Legislative Changes

Objectives: This study aimed to determine the oral morphine equivalents (OMEs) prescribed and refill rates following hysterectomy and hysteroscopy in the setting of opioid prescribing practice changes in 2 states. Design: This is a retrospective cohort analysis consisting of 2,916 patients undergoing hysterectomy or hysteroscopy between July 2016 and September 2019 at 2 affiliated academic hospitals in states that underwent legislative changes in opioid prescribing in 2018. Methods: Participants were identified using the Current Procedural Terminology procedure codes in Arizona and Florida. Hysterectomy was chosen as the most invasive gynecologic procedure, while hysteroscopy was chosen as the least invasive. Medical records were abstracted to find opioid prescriptions from 90 days before surgery to 30 days after discharge. Patients with opioid use between 90 and 7 days before surgery were excluded. Prescriptions were converted to OMEs and were calculated per quarter year. Statistical analysis included Wilcoxon rank sum t tests for OMEs and χ2 t tests for refill rates. Interrupted time-series analysis was used to determine significant change in OMEs before and after legislative change. Statistical analysis was performed using SAS version 9.4 (SAS Institute, Cary, NC, USA). Results: In Arizona, 1,067 hysterectomies were performed; 459 (43%) vaginal, 561 (52.6%) laparoscopic/robotic, and 47 (4.4%) abdominal. There were 530 hysteroscopies. Overall median OMEs decreased from 225 prior to July 2018 to 75 after July 2018 (p < 0.0001). The opioid refill rate remained unchanged at 7.4% (p = 0.966). In Florida, there were 769 hysterectomies; 241 (31.3%) vaginal, 476 (61.9%) laparoscopic/robotic, and 52 (6.8%) abdominal. There were 549 hysteroscopies. Overall median OMEs decreased from 150 prior to July 2018 to 0 after July 2018 (p < 0.0001). The opioid refill rate was similar (7.8% before July 2018 and 7.3% after July 2018; p = 0.739). Limitations: Limitations include involvement of a single hospital institution with a total of 10 fellowship-trained surgeons and biases inherent to retrospective study design. Conclusions: Legislative and provider-led changes coincided with decreases in opioid prescribing after 2018 in both states without increasing rates of refills and showed actual data reflected in the medical record. Gynecologists must actively participate in safe prescribing practices to decrease opioid dependence and misuse.

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Digital cognitive behavioural therapy for insomnia and primary care costs in England: an interrupted time series analysis

BJGP Open ◽

10.3399/bjgpo.2021.0146 ◽

2021 ◽

pp. BJGPO.2021.0146

Author(s):

Chris Sampson ◽

Eleanor Bell ◽

Amanda Cole ◽

Christopher B Miller ◽

Tracey Marriott ◽

...

Keyword(s):

Primary Care ◽

Time Series ◽

Cognitive Behavioural Therapy ◽

Interrupted Time Series ◽

Behavioural Therapy ◽

Interrupted Time Series Analysis ◽

Cognitive Behavioural ◽

Before And After ◽

Quasi Experimental ◽

Care Costs

BackgroundSleepio is an automated digital programme that delivers cognitive behavioural therapy for insomnia (dCBT-I). Sleepio has been proven effective in improving sleep difficulties. However, evidence for the possible impact of Sleepio use on health care costs in the United Kingdom has not previously been developed.AimWe sought to identify the effect of a population-wide rollout of Sleepio in terms of primary care costs in the National Health Service (NHS) in England.Design & settingThe study was conducted in the Thames Valley region of England, where access to Sleepio was made freely available to all residents between October 2018 and January 2020. The study relies on a quasi-experimental design, using an interrupted time series to compare the trend in primary care costs before and after the rollout of Sleepio.MethodWe use primary care data for people with relevant characteristics from nine general practices in Buckinghamshire. Primary care costs include general practice contacts and prescriptions. Segmented regression analysis was used to estimate primary and secondary outcomes.ResultsFor the 10,704 patients included in our sample, the total saving over the 65-week follow-up period was £71,027. This corresponds to £6.64 per person in our sample or around £70.44 per Sleepio user. Secondary analyses suggest that savings may be driven primarily by reductions in prescribing.ConclusionSleepio rollout reduced primary care costs. National adoption of Sleepio may reduce primary care costs by £20 million in the first year. The expected impact on primary care costs in any particular setting will depend on the uptake of Sleepio.

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Economic consequences of mandatory price re-registration for medicines from the high-cost nosology program

Kachestvennaya klinicheskaya praktika ◽

10.37489/2588-0519-2020-3-27-33 ◽

2020 ◽

pp. 27-33

Author(s):

A. V. Rudakova ◽

D. T. Ugrekhelidze ◽

V. A. Krylov

Keyword(s):

Russian Federation ◽

Economic Consequences ◽

Malignant Neoplasms ◽

Selling Price ◽

Pricing Policy ◽

Essential Drug List ◽

Before And After ◽

The Russian Federation ◽

The Government ◽

Reference Stock

The Government Decree, approved in December 2019, required registration certificates holders of reference drugs, included in the essential drug list (EDL), submit applications for mandatory price re-registration. Drugs included in the high-cost nosology list (high-cost list) must be included in the EDL.Objective: to assess the budget impact of price re-registration for high-cost list drugs.Material and methods. The comparing economic analysis of high-cost nosology program before and after price re-registration based on the Government Decree N 1683 (effective from 16.12.2019). 125 reference stock keeping units (SKUs), included in the high-cost list, were evaluated.Results. The analysis showed, that after re-registration the prices of 66 SKUs will remain the same. The prices of 43 reference SKUs will be reduced after setting a single maximum selling price («equalization»). Prices for 16 SKUs will be reduced due to lower registered prices in the reference countries. Considering the contracts executed in 20192020, the budget of the high-cost program is up to 74.430 billion rubles, and after re-registration it will be equal to 64.162 billion rubles, so the savings will amount 10.267 billion (13.8 %). The main drivers of re-registration prices savings are: Advagraf (1.175 billion rubles), Elizaria (2.083 billion rubles) and Revlimid (2.247 billion rubles). Separately, we analyzed the consequences ofprices re-registration in the V-thgroup ofhigh-cost list, which are provided topatients with malignant neoplasms of lymphoid, hematopoietic and related tissues. It was calculated, that in 2019 the contracts for V-th group of high-cost list were signed for 19.217 billion rubles, and after the price re-registration for the purchase of the same number of drugs 16.762 billion rubles will be spent, so the savings from the price re-registration will amount to 2.455 billion rubles (12.8 %), among which 2.247 billion rubles will be provided by price re-registration of Revlimid.Conclusions. The pricing policy implemented in the Russian Federation is aimed at increasing the availability of highly effective medical care to the population of the Russian Federation and significantly reduces the burden on the budget of the healthcare system.

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Impact of Donation Physicians on Deceased Organ Donation: A Systematic Review

10.21203/rs.3.rs-200397/v1 ◽

2021 ◽

Author(s):

Janet E. Squires ◽

Laura D. Aloisio ◽

Wilmer John Santos ◽

Danielle Cho-Young ◽

Monica Taljaard ◽

...

Keyword(s):

Systematic Review ◽

Organ Donation ◽

Interrupted Time Series ◽

Deceased Donor ◽

Organ Donors ◽

Consent Rate ◽

Team Members ◽

Study Selection ◽

Before And After ◽

Deceased Organ Donation

Abstract Background: An emerging strategy to increase deceased organ donation is to use dedicated donation physicians to champion organ donation. We sought to conduct a systematic review of the effectiveness of donation physicians in improving organ donation outcomes.Methods: A systematic review was conducted following Cochrane principles. MEDLINE, Embase, and CINHAL databases were searched from inception to March 26, 2020. Quantitative studies examining the effects of donation physicians on all deceased organ donation outcomes were considered for inclusion. Review articles, editorials and opinion articles, and case studies were excluded. Study selection was completed independently by two team members; all discrepancies were resolved by consensus. Two team members independently extracted data from studies. Results: A total of 1,017 studies were screened, and 12 met inclusion criteria. Included studies were published between 1994 and 2019. Half used an interrupted time series design (n = 6; 50%), three (25%) were cohort studies, and three (25%) used a before-and-after study design. Outcomes (reported in greater than 50% of included articles) included consent/refusal rate (n = 8; 67%), number of potential donors (n = 7; 58%), and number of actual donors (n = 7; 58%). Across studies and design types, there was an increase in potential organ donors ranging from 8 to 143% (Mdn = 33%), an increase in actual organ donors from 15 to 113% (Mdn = 27%), an increase in donor consent rate from -3 to 258% (Mdn = 12%) and an increase in deceased donor transplants from 13 to 24% (Mdn = 19%) following the introduction of donation physicians.Conclusions: Donation physicians have the potential to significantly improve deceased organ donation. Further implementation and evaluation of donation physician programs is warranted. However, implementation should be undertaken with a clear plan for a methodologically rigorous evaluation of outcomes.

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ED syphilis and gonorrhea/chlamydia cotesting practices before and after the implementation of an electronic health record-based alert

Emergency Medicine Journal ◽

10.1136/emermed-2020-210331 ◽

2021 ◽

pp. emermed-2020-210331

Author(s):

James S Ford ◽

Tasleem Chechi ◽

Michella Otmar ◽

Melissa Baker ◽

Sarah Waldman ◽

...

Keyword(s):

Electronic Health Record ◽

Underserved Populations ◽

Cohort Analysis ◽

Treponema Pallidum ◽

Interrupted Time Series ◽

Health Record ◽

Interrupted Time Series Analysis ◽

Syphilis Testing ◽

Before And After ◽

Electronic Health

BackgroundThe prevalence of syphilis is increasing in many countries, including the USA. The ED is often used by underserved populations, making it an important setting to test and treat patients who are not evaluated in outpatient clinical settings. We aimed to assess the utility of an ED-based syphilis and gonorrhoea/chlamydia cotesting protocol by comparing testing practices before and after its implementation.MethodsWe implemented an electronic health record (EHR) alert that prompted clinicians to order syphilis testing in patients undergoing gonorrhoea/chlamydia testing. We performed a retrospective cohort analysis that compared outcomes between the preimplementation period (January–November 2018) and the postimplementation period (January–November 2019). Patients were tested for Treponema pallidum antibody (TPA) using a multiplex flow immunoassay (MFI), and positive results were confirmed by rapid plasma reagin (RPR). The primary implementation outcome was the number of syphilis tests/month, and the primary clinical outcome was the number of syphilis diagnoses/month (defined as positive TPA MFI and RPR). We performed an interrupted time-series analysis to evaluate the effect of implementing the alert over time.ResultsFour-hundred and ninety-four and 1106 unique patients were tested for syphilis in the preimplementation and postimplementation periods, respectively. Syphilis testing increased by 55.6 tests/month (95% CI 45.9 to 65.3, p<0.001) following alert implementation. Patients tested in the postimplementation period who were tested using the alert were much younger (difference: 14 years (95% CI 12 to 15)) and were more likely to be female (difference: 15% (95% CI 8 to 21)) and African-American (difference: 11% (95% CI 5 to 17)) than patients tested by clinician-initiated testing. Presumptive syphilis diagnoses increased from 3.4 diagnoses/month to 7.9 diagnoses/month (difference, 4.5 (95% CI 2.2 to 6.9), p<0.001).ConclusionsOur study demonstrates that use of a targeted EHR alert testing protocol can increase syphilis testing and diagnosis and may reduce clinician bias in testing.

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