Economics of Formulary Design and Mental Health Policy

描述（由申请人提供）：处方药已成为心理健康治疗中越来越重要的组成部分，近年来精神药物的费用迅速增加。然而，我们对精神药物治疗的经济学知识还存在很大的差距。这项指导研究科学家发展奖将使具有精神卫生政策和经济机构专业知识的卫生经济学家Haiden Huskamp博士能够用对用于治疗精神疾病的处方药的经济学进行临床相关和具有政策意义的研究所需的知识和技能来补充她的经济工具。该职业发展建议的具体目标是：1)加深对与精神药物使用相关的临床决策的理解；2)掌握精神药理学基础知识；3)扩大对影响处方药市场的重要经济制度的认识。在这项工作中，Huskamp博士将由她的赞助人Richard Frank博士和共同赞助人Andrew Nierenberg医学博士和Ernst Berndt博士指导。她的职业发展计划包括在尼伦伯格博士的指导下学习与治疗决策相关的临床问题。Berndt和Frank在医药市场的经济制度，以及课程和参与精神药理学“大查房”，相关的系列研讨会，和专业会议。Huskamp博士将利用这些职业发展活动中获得的知识和技能来开展三个研究项目。第一个项目考察了选择性5 -羟色胺再摄取抑制剂（SSRls）类仿制药对抗抑郁药的使用模式、成本和市场份额的影响，以及品牌抗抑郁药制造商在药品价格和促销支出方面的竞争反应。第二个项目评估三级药物处方所产生的经济激励，以及这些安排如何影响非老年人口的成本、使用模式和对治疗指南的遵守。该项目包括对与限制性公式相关的权衡进行经济福利分析。第三个项目审查了三级处方对退休人员精神药物成本和使用模式的影响，并探讨了处方对在医疗保险中增加处方药福利的精神健康成本的影响，以及对在这种福利下获得适当精神药物治疗的影响。拟议的职业发展计划将为Huskamp博士提供培训、指导、时间和资源，以发展技能，使她能够领导精神疾病药物治疗经济学的独立研究。

DESCRIPTION (provided by applicant): Prescription drugs have become an increasingly important component of mental health treatment and the costs of psychotropic drugs have increased rapidly in recent years. However, there are major gaps in our knowledge about the economics of psychotropic drug treatment. This Mentored Research Scientist Development Award would allow Dr. Haiden Huskamp, a health economist with expertise in mental health policy and economic institutions, to supplement her economic tools with the knowledge and skills needed to conduct clinically-relevant and policy-significant research on the economics of prescription drugs used in the treatment of mental illnesses. The specific aims of this career development proposal are to: 1) develop a greater understanding of clinical decision-making related to the use of psychotropic drugs; 2) acquire basic knowledge of psychopharmacology; and 3) expand knowledge of the important economic institutions influencing the prescription drug market. In this undertaking, Dr. Huskamp will be guided by her sponsor, Richard Frank, PhD, and co-sponsors, Andrew Nierenberg, MD, and Ernst Berndt, PhD. Her career development plan includes guided study with Dr. Nierenberg on clinical issues related to treatment decision-making and Drs. Berndt and Frank on economic institutions of the pharmaceutical market, as well as coursework and participation in psychopharmacological "Grand Rounds," relevant seminar series, and professional meetings. Dr. Huskamp will use the knowledge and skills developed through these career development activities to conduct three research projects. The first project examines the effect of generic entry in the class of selective serotonin reuptake inhibitors (SSRls) on utilization patterns, costs, and market share among antidepressants as well as the competitive response of brand antidepressant manufacturers with respect to drug prices and promotional spending. The second project assesses the economic incentives created by three-tier drug formularies and how these arrangements affect costs, utilization patterns, and adherence to treatment guidelines in a non-elderly population. This project includes an economic welfare analysis of the tradeoffs associated with restrictive formularies. The third project examines the effect of a three-tier formulary on psychotropic drug costs and utilization patterns in a retiree population and explores the impact of formularies on the mental health costs of adding a prescription drug benefit to Medicare and on access to appropriate psychotropic drug treatment under such a benefit. The proposed plan of career development will provide Dr. Huskamp the training, mentoring, time and resources to develop the skills that will put her in a position to lead independent research on the economics of pharmaceutical treatment for mental illnesses.