Drug utilization and cost in a Medicaid population: a simulation study of community vs. mail order pharmacy.
Drug utilization and cost in a Medicaid population: a simulation study of community vs. mail order pharmacy.
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DOI：
10.1186/1472-6963-7-122
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发表时间：
2007-07-30
影响因子：
2.8
通讯作者：
Szeinbach SL
中科院分区：
文献类型：
--
作者：
Valluri S;Seoane-Vazquez E;Rodriguez-Monguio R;Szeinbach SL
门诊药物通过社区和邮购药房分发。没有经验证据表明，以邮购取代社区药房会降低总体药物支出。需要评估的潜在影响的利用率和成本的可能扩展的邮购服务在医疗补助提供了进行这项研究的理由。本研究比较了医疗补助人群中社区与邮购药房配药服务的药物利用率和药物产品成本。本研究是一项回顾性队列研究，比较社区与邮购药房的利用率和成本模式。利用社区药房索赔数据，建立了一个模拟模型来评估邮购药房的药物利用和成本。该模型假设，在邮购药房的药物治疗（CDT）的课程将有类似的社区药房中发现的利用模式。平均利用率和平均成本变化的95%置信区间估计使用自助分析。通过改变药物选择标准和供应、填充点和药物拥有率（MPR）进行敏感性分析。进行子分析，以解决邮购和社区药房之间与治疗类别和双重合格患者相关的差异。研究数据来自2000年1月至2004年9月期间俄亥俄州医疗补助计划的药房索赔数据库。汇总药物索赔，以获得一组代表唯一患者ID和唯一药品的CDT。药品成本估计不包括配药费，并用于估计邮购所需的成本降低，以使其与社区药房相比成本中性。基线模型显示，邮购与社区药房的使用将导致药物利用率增加5.5%，邮购成本降低5.4%，从而实现成本中性。俄亥俄州医疗补助计划长期使用药物的结果显示，与社区药房相比，使用率增加了5.1%，成本降低了4.9%，成为成本中性。仿真结果表明，邮购药房增加了药品利用率，如果单位成本不相应降低，也会增加药品成本。应事先考虑患者人群、每日供应、疾病、治疗和保险特征，以确保适当使用邮购药房服务。
Outpatient drugs are dispensed through both community and mail order pharmacies. There is no empirical evidence that substitution of community pharmacy with mail order reduces overall drug expenditures. The need for evaluating the potential effects on utilization and costs of the possible extension of mail order services in Medicaid provides the rationale for conducting this study. This study compares drug utilization and drug product cost in community vs. mail order pharmacy dispensing services in a Medicaid population. This study is a retrospective cohort study comparing utilization and cost patterns in community vs. mail order pharmacy. A simulation model was employed to assess drug utilization and cost in mail order pharmacy using community pharmacy claim data. The model assumed that courses of drug therapy (CDT) in mail order pharmacy would have utilization patterns similar to those found in community pharmacy. A 95% confidence interval surrounding changes in average utilization and average cost were estimated using bootstrap analysis. A sensitivity analysis was performed by varying drug selection criteria and supply, fill point, and medication possession ratio (MPR). Sub-analyses were performed to address differences between mail order and community pharmacy related to therapeutic class and dual-eligible patients. Data for the study derived from pharmacy claims database of Ohio Medicaid State program for the period January 2000-September 2004. Drug claims were aggregated to obtain a set of CDTs representing unique patient IDs and unique drug products. Drug product cost estimates excluded dispensing fees and were used to estimate the cost reduction required in mail order to become cost neutral in comparison with community pharmacy. The baseline model revealed that the use of mail order vs. community pharmacy would result in a 5.5% increase in drug utilization and a 5.4% cost reduction required in mail order to become cost neutral. Results from Ohio Medicaid drugs for chronic use revealed a 5.1% increase in utilization and a 4.9% cost reduction required to become cost neutral in comparison with community pharmacy. The results of the simulation model indicate that mail order pharmacy increases drug utilization and can also increase drug product cost if the cost per unit is not reduced accordingly. Prior consideration should be given to the patient population, day-supply, disease, therapy, and insurance characteristics to ensure the appropriate use of mail order pharmacy services.
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影响因子：
4.4
作者：
WERTHEIMER, AI;ANDREWS, KB
通讯作者：
ANDREWS, KB
影响因子：
3.1
作者：
Bachmann, LH;Stephens, J;Hook, EW
通讯作者：
Hook, EW
影响因子：
2.1
作者：
Carroll, Norman V.;Brusilovsky, Ilia;Oscar, Robert
通讯作者：
Oscar, Robert
影响因子：
6.6
作者：
KIRKING, DM;ASCIONE, FJ;RICHARDS, JW
通讯作者：
RICHARDS, JW
DOI：
10.1080/09540120020018161
发表时间：
2001-02-01
影响因子：
1.7
作者：
Murphy, DA;Wilson, CM;Belzer, M
通讯作者：
Belzer, M