Did the universal zero-markup drug policy lower healthcare expenditures? Evidence from Changde, China

Background The zero-markup drug policy (also known as the universal zero-markup drug policy (UZMDP)) was implemented in stages beginning with primary healthcare facilities in 2009 and eventually encompassing city public hospitals in 2016. This policy has been a central pillar of Chinese health reforms. While the literature has examined the impacts of this policy on healthcare utilization and expenditures, a more comprehensive and detailed assessment is warranted. The purpose of this paper is to explore the impacts of the UZMDP on inpatient and outpatient visits as well as on both aggregate healthcare expenditures and its various components (including drug, diagnosis, laboratory, and medical consumables expenditures). Methods A pre-post design was applied to a dataset extracted from the Changde Municipal Human Resource and Social Security Bureau comprising discharge data on 27,246 inpatients and encounter data on 48,282 outpatients in Changde city, Hunan province, China. The pre-UZMDP period for the city public hospitals was defined as the period from October 2015 to September 2016, while the post-UZMDP period was defined as the period from October 2016 to September 2017. Difference-in-Difference negative binomial and Tobit regression models were employed to evaluate the impacts of the UZMDP on healthcare utilization and expenditures, respectively. Results Four key findings flow from our assessment of the impacts of the UZMDP: first, outpatient and inpatient visits increased by 8.89 % and 9.39 %, respectively; second, average annual inpatient and outpatient drug expenditures fell by 4,349.00 CNY and 1,262.00 CNY, respectively; third, average annual expenditures on other categories of healthcare expenditures increased by 2,500.83 CNY, 417.10 CNY, 122.98 CNY, and 143.50 CNY for aggregate inpatient, inpatient diagnosis, inpatient laboratory, and outpatient medical consumables expenditures, respectively; and fourth, men and older individuals tended to have more inpatient and outpatient visits than their counterparts. Conclusions Although the UZMDP was effective in reducing both inpatient and outpatient drug expenditures, it led to a sharp rise in other expenditure categories. Policy decision makers are advised to undertake efforts to contain the growth in total healthcare expenditures, in general, as well as to evaluate the offsetting effects of the policy on non-drug components of care.

Association of Insurance Type on Outpatient Copayments and Drug Utilization of Oral Multiple Myeloma Medications Via All-Claims Analysis, 2014-2018

Introduction Currently, there are three FDA-approved novel multiple myeloma (MM) oral agents commonly used in clinical practice in the United States: two immunomodulators (lenalidomide [len] and pomalidomide [pom]) and one proteasome inhibitor (ixazomib [ixa]). The financial burden faced by patients with MM on these drugs can be considerable due to increasing long-term survival and extended periods of continuous single agent maintenance or multidrug combination regimens. To better understand the financial burden associated with extended use of these medications, we sought to leverage a real-world, all-claims insurance database to examine the outpatient drug copayments, associated fill patterns, and duration of therapy of these MM oral agents, stratified by insurance type. We hypothesize that copayments associated with oral MM agents will comprise a major portion of the overall drug copayment per patient, and fill patterns and duration of therapy of these medications will vary across patients of different insurance types. Methods We utilized outpatient drug claims derived from the 2014-2018 IBM/Truven MarketScan Commercial, Medicare Advantage, and Medicaid all-claims databases and extracted all outpatient claims from patients who filled at least one prescription (≥28-day duration) for len, pom, or ixa. Annual outpatient medication copayment and number of outpatient scripts were calculated for each patient, both for oral MM agents only and all outpatient prescriptions. Copayments were normalized to the cost per annum. Multivariable linear regression was used to compare outcomes between patients of the three insurance types. Results From 2014-2018, we identified 10,750 patients on len, 2,355 patients on pom, and 794 patients on ixa. These included patients with commercial insurance (53.5%), Medicare Advantage (37.8%), and Medicaid (8.7%). The average adjusted annual copayment per patient of len was $445 for commercial, $480 for Medicare Advantage, and $48 for Medicaid (Table 1). Len copayment comprised of 77-83% of the total outpatient drug copayment per patient. For pom, adjusted copayments were $460 for commercial, $749 for Medicare Advantage, and $128 for Medicaid. Pom copayment comprised 54-90% of the total. For ixa, adjusted copayments were $584 for commercial, $448 for Medicare Advantage and $2 for Medicaid. Ixa copayment comprised 7-48% of the total. Patients with commercial insurance generally filled more scripts for oral MM agents per year (6 len, 4 pom, 5 ixa) compared to those with Medicare Advantage (5 len, 5 pom, 4 ixa) and Medicaid (4 len, 4 pom, 4 ixa) (Table 2). However, patients with commercial insurance filled fewer overall outpatient scripts per year (31-37) compared to Medicare Advantage (35-42) and Medicaid (40-52). Insurance type was associated with the number of scripts filled for len (p<0.0001) and ixa (p=0.01) after adjustment for age, but not pom (p=0.14). Among patients on oral MM therapy for more than one year, insurance type was associated with time on therapy for len (828 days for commercial, 873 days for Medicare Advantage, and 791 days for Medicaid, p=0.0004) (Table 3). However, insurance type was not associated with time on therapy for pom (p=0.83) or ixa (p=0.11). Discussion Our results demonstrate that copayments for oral MM agents comprise the majority of total outpatient drug copayments for patients with MM, suggesting that the out-of-pocket costs of these agents may be a key driver of financial burden. In addition to differences observed in the oral MM drug copayments, insurance type was also associated with the number of scripts filled and time on therapy for patients taking len. Thus, this suggests insurance type is also linked to drug utilization patterns and may indicate a differential financial burden in patients with MM on chronic oral therapy. Reducing the cumulative impact of financial toxicity for patients with MM is an important consideration for prescribers, payors, and health systems to achieve optimal clinical outcomes. Although our current dataset lacks diagnostic and treatment data, further correlative studies incorporating care utilization data, including inpatient admissions and outpatient clinical visits, are in progress. Figure 1 Figure 1. Disclosures Pianko: Karyopharm: Honoraria.

INITIALLY BUILDING AND APPLYING A LIST OF DRUG INTERACTIONS AT VINH LONG GENERAL HOSPITAL, IN 2020

Background: Drug interactions are the main causes of adverse drug events. In order to promptly detect, and handle drug interactions, medical staff often have to look up information in different databases. However, in practice this is still difficult. Stemming from practical needs, we conducted the study "Initially building and applying a list of drug interactions at Vinh Long General Hospital, in 2020". Methods: The study built a list of drug interactions appearing in the list of outpatient drugs at Vinh Long General Hospital. Then, the above list was used to examine the drug interaction on 260 outpatient prescriptions at the hospital. Results: The main findings show that 23 pairs of interactions appearing in the outpatient drug list applied at Vinh Long General Hospital; The rate of prescriptions with interactions is still quite high (44.2%). Among prescriptions with interactions: the rate of prescriptions with 1 interaction was 58.2%; 13% of prescriptions have 3 types of interactions and 4.5% of prescriptions have more than 3 types of interactions. The proportion of prescriptions with interactions at level 1 – "need to be monitored" accounted for 72.2%. The rate of prescriptions with serious interactions requiring replacement of other drugs was 11.3% and contraindications was 2.6%.

EVALUASI PENGGUNAAN OBAT ANTIHIPERTENSI PADA PASIEN GERIATRI RAWAT JALAN DI RSUD DR. A. DADI TJOKRODIPO

Hypertension is a condition in which systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg. Hypertension is often found in geriatrics that can affect the onslence of heart disease and blood vessels. Increased cases of hypertension, the rational use of drugs by hypertensive patients is one of the important elements in achieving health quality. The purpose of this study is to find out the harsh use of antihypertensive drugs in outpatient geriatric patients at Dr. A. Dadi Tjokrodipo Hospital bandar Lampung. This type of research is non experimental with a descriptive design using retrospective data with purposive sampling methods. The results of the study were based on the pattern of use of antihypertensive with the ATC/DDD method in hypertension patients in Dr. A. Dadi Tjokrodipo Bandar Lampung city is 5331,03 DDD/1000 KPRJ, there are nine types of antihypertensive used, namely amlodipine, lisinopril, candesartan, irbesartan, furosemide, spironolactone, ramipril, bisoprolol and captopril. Antihypertensive in the drug uses segment 90%, namely amlodipine 44.37%, lisinopril 16.88%, candesartan 15.46% and irbesartan 13.65%. The study was based on 100% patient accuracy criteria, 100% indication accuracy, 89.3% drug accuracy and 92% dose accuracy. The conclusion of this study, the pattern of use of antihypertensive widely used is amlodipine amounting to 2365.52 DDD/1000 KPRJ, antihypertensive that enters the drug uses segment 90% namely amlodipine, lisinopril, candesartan and irbesartan.Keywords: Antihypertensive, Geriatrics, Outpatient, Drug Use

Rationale for a New Outpatient Drug Therapy Algorithm in COVID-19 Patients Based on the Principle of «Multi-hit» Approach

The aim of the work was to justify the algorithm of outpatient drug therapy in patients with COVID-19, based on the principle of «Multi-hit» Approach. The algorithm is based on the published results of clinical studies and observations, authors’ own practical experience in the use and management of more than 4 thousand patients diagnosed with COVID-19 of varying severity during the 2020 pandemic. The article substantiates a complex algorithm for the treatment of outpatients with COVID-19, which includes etiotropic, pathogenetic, and symptomatic components of therapy with different mechanisms of action. The described approach is the 1st stage (outpatient) of a complex algorithm for managing patients with COVID-19. It has been successfully implemented in the system of outpatient care for patients with novel coronavirus infections in several leading medical institutions in Russia. The authors believe that the developed algorithm for providing outpatient drug therapy for COVID-19, based on the principle of multiple exposure, may be useful in real clinical practice of managing patients with coronavirus infection.

CURRENT SITUATION OF OUTPATIENT DRUG PRESCRIPTION FOR OBSTETRICS AND GYNECOLOGY

Objective: Describing the current situation of outpatient drug prescriptions at the Department of Obstetrics and Gynecology, Tan Chau Regional General Hospital, An Giang Province in 2019. Subjects and methods: Study of cross-sectional description over 400 oupatient treatment prescriptions stored at the Department of Obstetrics and Gynecology, Tan Chau Regional General Hospital, An Giang Province during from January 1st, 2019 to December 31st, 2019. Results: Comply with the provisions in the prescription; 100% of prescriptions were fully filled out the name, age, sex, diagnosis, cross out the blank, full name and signature of the doctor, the amount of medicine; 100% full patient address; 78.25% written their original names in accordance with regulations; 89.00% recorded sufficient content; 100% indication of the full dose and time of drug usage; 100% full used way. The average number of drugs in 1 prescription was 4.53; 80.75% of drugs were prescribed by the original name; 20.50% of prescriptions had antibiotics; 14.0% of prescriptions had vitamins; 100% of the drugs prescribed were on the essential drug formulary and the hospital formulary. Conclusion: A high proportion of compliance with regulations on prescription was observed. The average number of drugs in 1 prescription was 4.53. Mainly, drugs were prescribed by original name, drugs in the essential drug formulary, the proportion of prescriptions with antibiotics and vitamins was low.

History and modern problems of providing dispensary drug treatment

The article presents an analysis of the history of development and identified problems in the system of outpatient drug treatment. The main issues of providing drug treatment to the population and possible prospects for the development of the system of outpatient drug treatment are considered.