Impact of Medicaid Policy on cardiovascular drug use and clinical outcomes

描述（由申请人提供）：治疗心血管疾病的药物为患者提供了重要的益处，并且在理想的情况下，处方可以挽救生命和金钱。然而，许多心血管药物的高成本让保险公司感到担忧，尤其是在医疗补助等公共项目中，这些项目面临着严重的预算限制。医疗补助计划实施了成本控制政策，以减少某些药物的使用。在这样做的过程中，项目试图通过减少高效药物的使用来限制过度昂贵药物的使用，而不会产生不良的临床后果。用于控制药品费用政策的不同办法的相对效力尚未得到很好的了解。我们将利用我们之前的研究，根据医疗补助计划试图改变药物使用的方式，对心血管药物的成本控制政策进行识别和分类。利用我们已经获得的大型患者级医疗补助数据库，我们将评估每种不同政策方法对药物使用和临床结果的影响，并比较不同的控制成本技术在不引起不良临床事件的情况下限制药物费用的效果。研究小组在评估药物政策和处理大型索赔数据集方面具有丰富的经验，确保进行高质量的研究，使政策制定者和负责卫生系统设计的决策者能够评估减少使用昂贵药物所节省的费用与在不使用所需药物时可能出现的不良临床结果之间的平衡。我们将重点介绍四类药物：(1)抗血小板药物；(2)他汀类药物;(3)降压药;(4)口服降糖药。我们将收集这些类别中所有药物的医疗补助成本控制政策的详细数据，并根据我们早期的研究将其分类。我们将评估总体和个别水平上的利用率变化。我们的临床结果将是心血管事件，包括心肌梗死、中风和血运重建术。我们将评估整个医疗补助计划的药物使用结果和临床结果，但将特别关注受特定政策影响的药物适应症的患者群体，为政策制定者提供明确的有针对性的政策如何有效的感觉。通过评估多种药物类别的药物使用和临床结果，我们将对心血管药物的医疗补助报销政策进行全面的描述。这些研究结果将为这些常用的政策技术提供比较有效性的数据，而在此之前的研究有限。我们的研究结果将为决策者和交付系统决策者提供有关成本控制政策方法的近期和长期影响的关键信息。

DESCRIPTION (provided by applicant): Medications treating cardiovascular conditions offer important benefits for patients and, when prescribed ideally, can save both lives and money. However, the high cost of many cardiovascular medications concerns insurers, especially in public programs such as Medicaid which face severe budget constraints. Medicaid programs have implemented cost-containment policies to reduce the use of some medications. In doing this, programs seek to limit the use of overly expensive medications without creating adverse clinical consequences by reducing the use of highly effective drugs. The comparative effectiveness of the different approaches used for drug cost-containment policy is not well understood. We will draw on our prior research to identify and classify Medicaid cost-containment policies for cardiovascular drugs based on the manner in which they attempt to change medication use. Using large patient-level Medicaid databases, to which we have already obtained access, we will evaluate the impact of each different policy approach on medication use and clinical outcomes and compare how well different techniques for containing costs can limit medication expenses without causing adverse clinical events. The research team has extensive experience in evaluating drug policy and in working with large claims datasets, ensuring that high-quality studies will be performed, allowing policy makers and decision makers charged with health systems design to evaluate the balance between savings from reduced use of costly medications and possible adverse clinical outcomes when needed drugs are not used. We will focus on four medications classes: (1) antiplatelet agents; (2) statins; (3) antihypertensives; and (4) oral hypoglycemics. We will collect detailed data on Medicaid cost-containment policies for all medications in these classes and categorize them into a classification system derived from our earlier studies. We will evaluate changes in utilization at both the aggregate and individual levels. Our clinical outcomes will be cardiovascular events, including myocardial infarction, stroke, and revascularization. We will evaluate drug utilization outcomes and clinical outcomes in the overall Medicaid programs but will focus in particular on patient cohorts with an indication for the medication affected by a given policy, offering policy-makers a clear sense of how well targeted policies work. By evaluating drug use and clinical outcomes across multiple medication classes, we will develop a thorough depiction of Medicaid reimbursement policy for cardiovascular medications. The findings will provide comparative effectiveness data for these commonly used policy techniques, on which there is limited prior research. Our results will provide critical information for policy makers and delivery system decision makers about both the immediate and longer-term effects of cost-containment policy approaches. PUBLIC HEALTH RELEVANCE: Policies to control the use of cardiovascular medications are commonly used in public and private programs despite a lack of comparative evidence on whether they achieve savings and how such savings might balance against changes in clinical events. Drawing on years of experience in studying Medicaid policy and using large patient-level Medicaid data sets, we will measure the comparative effectiveness of Medicaid policies on cardiovascular drug spending and assess whether reduced drug use is associated with adverse clinical outcomes, providing critical information for policy-makers and health system design decision makers.