Economics of Formulary Design and Mental Health Policy

描述(申请人提供)：处方药已成为精神卫生治疗的一个越来越重要的组成部分，近年来精神药物的成本迅速增加。然而，我们对精神药物治疗的经济学知识存在重大差距。海登·赫斯坎普博士是一位在精神卫生政策和经济机构方面具有专业知识的健康经济学家，通过这项有指导意义的研究科学家发展奖，她可以为自己的经济工具补充所需的知识和技能，以便对用于治疗精神疾病的处方药的经济学进行具有临床相关性和重大政策意义的研究。这项职业发展建议的具体目的是：1)更好地了解与使用精神药物有关的临床决策；2)获得精神药理学的基本知识；3)扩大对处方药市场有影响的重要经济机构的知识。在这项工作中，赫斯坎普博士将由她的赞助人理查德·弗兰克博士、共同赞助人安德鲁·尼伦伯格医学博士和恩斯特·伯恩特博士指导。她的职业发展计划包括与尼伦伯格博士就与治疗决策相关的临床问题进行指导研究，与Berndt博士和Frank博士就药品市场的经济机构进行指导研究，以及课程作业和参与精神药理学“大轮回”、相关研讨会系列和专业会议。赫斯坎普博士将利用通过这些职业发展活动获得的知识和技能进行三个研究项目。第一个项目考察了选择性5-羟色胺再摄取抑制剂(SSRL)的仿制药进入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创造的经济激励，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。这个项目包括对与限制性公式相关的权衡的经济福利分析。第三个项目审查了三级处方对退休人口中精神药物费用和使用模式的影响，并探讨了处方对将处方药福利添加到医疗保险中的精神健康成本以及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赫斯坎普博士提供培训、指导、时间和资源，以培养她的技能，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.