Hyperactivity Disorder Among Medicaid Patients In The United States

Hyperactivity Disorder Among Medicaid Patients In The United States

VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8 finding. Budget Impact analysis indicated that Vortioxetine is associated with minimum fund...

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VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8

finding. Budget Impact analysis indicated that Vortioxetine is associated with minimum fund expenditure. wtP/CER was best for Vortioxetine (35,5) according to pharmacoeconomic expediency analysis.  Conclusions: Adverse event costs constitute a significant portion of depression treatment costs; Possessing a favorable combination of clinical effectiveness and tolerability parameters, Vortioxetine dominates both in terms of raw effectiveness and cost-effectiveness; aforementioned result is robust according to sensitivity analysis; Both complete and incomplete suicide contribute strongly to the budgetary burden; According to Budget Impact Analysis, Vortioxetine use is associated with a decreased budgetary burden, which is explained by low suicidogenic potential and high cost effectiveness; Paroxetine use is associated with a very high budgetary burden, 60,3% higher than Vortioxetine (especially relevant given that Paroxetine remains widespread in Russian clinical practice); Among the compounds investigated in this study, Vortioxetine is the most attractive antidepressant from the Russian Federation’s drug reimbursement system point of view. PMH30 A Preliminary Analysis Of Health Care Resource Utilization Of Paliperidone Palmitate In The Treatment Of Schizophrenia In The Public Health Care Sector Of Hong Kong Choon WY Monash University Malaysia, Selangor, Malaysia

Objectives: The objective of this study was to compare the health care resources utilization and associated cost of schizophrenic patients from 2 regional public hospitals before and after the initiation of paliperidone palmitate long acting injection (PPLA) treatment of a patient cohort of about 300 patients.  Methods: This was a retrospective cost analysis study. The study was performed from a public health care institute’s perspective. The utilization of health care resources was captured via case record review. Patients started on antipsychotic treatment but switched to PPLA due to adverse effects, poor response or other reasons, and who received at least one dose of PPLA, and have sufficient continuous monitoring record pre- and posttreatment on paliperidone palmitate for a minimum of 24 months were studied. The initial PPLA administration date served as the index date. Study period included 12-month pre and 24-month post the index date, and patients served as their own control. Cost data collected included medications, laboratory procedures, other more sophisticated investigational procedures (e.g. CT, MRI), regular and extra outpatient clinic visits, emergency room utilization, hospitalization, and other health care services such as special counseling sessions.  Results: The data of the first 65 patients who received PPLA treatment from 2 public hospitals over the period of 2011-2014 was analyzed. The overall annual cost of treatment before and after PPLA was HKD22 million (USD2.8 million; 1USD= 7.8HKD) and HKD13 million (USD1.7 million) respectively. The annual average cost per patient before and after PPLA treatment was HKD357,188 (USD46,083) and HKD214,313 (USD27,650).  Conclusions: Hospitalization due to either poor control or adverse effects seems to be the key driver of increased costs of care in a group of patients receiving PPLA treatment for schizophrenia. PPLA treatment appears to be able to substantially reduce hospital stay and hence cost of hospitalization. PMH31 The Association Between Buprenorphine Medication-Assisted Treatment Adherence And Health Care Service Utilization And Costs Tkacz J1, Brady B1, Nadipelli V2, Volpicelli J3, Ronquest N2, Un H4, Ruetsch C1 of Addiction Medicine, Plymouth Meeting, PA, USA, 4Aetna, Blue Bell, PA, USA

1Health Analytics, Columbia, MD, USA, 2Indivior, Richmond, VA, USA, 3Institute

Objectives: Buprenorphine medication assisted treatment (B-MAT) is an effective therapy for opioid use disorder (OUD) but may be considered cost-prohibitive based on pharmacy cost alone. This study estimated buprenorphine adherence and associated healthcare costs within a sample of OUD patients treated with B-MAT.  Methods: Medical and pharmacy claims for members with a diagnosis of opioid dependence (ICD-9 304.0 and 304.7), abuse (305.5), or poisoning (965.0) were provided by Aetna (Blue Bell, PA) from Q1 2012 through Q1 2015. B-MAT members were identified and placed into adherent (n =  205) or non-adherent (n =  272) groups based on their one-year buprenorphine medication possession ratio (MPR of ≥  0.80). Buprenorphine non-adherence was further examined by dividing the non-adherent group into 4 subgroups by 0.20 MPR increments. Healthcare service utilization and expenditure was measured over the 12-month period following B-MAT initiation. Service utilization and cost differences between groups were assessed via MannWhitney U tests; chi-square tests of equality of proportions were used for categorical variables. Linear contrasts were estimated with one-way analyses of variance of logged-transformed costs.  Results: Compared to non-adherent members, adherent members incurred significantly greater office visits, total prescription fills, and pharmacy costs (ps <  0.01), but significantly lower outpatient hospital, ER, and inpatient visits and costs, and overall medical costs (ps <  0.05). The MPR subgroups demonstrated statistically significant linear contrasts on four cost metrics: pharmacy, outpatient hospital, inpatient hospital, and total medical (ps <  0.05). With the exception of pharmacy costs, which increased with MPR, increased adherence was associated with overall decreased healthcare costs.  Conclusions: Buprenorphine adherence is associated with increased pharmacy costs, but reduced high cost venue services and overall medical costs compared to non-adherence. The linear relationships observed in this study are evidence of a direct link between B-MAT adherence and reduced total medical expenditure. PMH32 Cost Of Mental Illness Studies: A Descriptive Analysis Of Design Characteristics And Costs Tenkeu S1, Okeh A1, Onukwugha E2 of Maryland, Baltimore, MD, USA, 2University of Maryland School of Pharmacy, Baltimore, MD, USA 1University


Objectives: Cost of mental illness studies are important in the decision making process for allocating resources or setting priorities for mental healthcare and prevention. Summary information regarding available cost-of-illness (COI) studies can help identify areas for future study to support decision making. We performed a descriptive analysis of cost of mental illness studies, focusing on design characteristics and costs.  Methods: We identified all cost of mental illness (ICD10 diagnosis group: Mental and Behavioral Disorders) studies represented in a database of COI articles published between 2005 and 2014. We examined information on study perspective, cost type (e.g., direct medical, direct non medical), data source, funding source, publication year, and geographic income region. We also reported the average patient cost by currency for recent publications (i.e., 2011 to 2014).  Results: There were 84 articles included in the study. The proportion of studies that reported 1) Patient/caregiver, 2) Societal, 3) Private payer or Public payer, 4) Other and 5) Not available perspectives were as follows: 3.6%, 62%, 6% or7%, 1% and 18%. The proportion of studies that included direct medical cost, direct non-medical costs, indirect costs and intangible costs at all were as follows: 98%, 54%, 62%, 5%. The distribution in terms of geographic income region was as follows: 86% for high income region, 9.52% for middle income and 0% for low income region. The top three categories for funding were: pharmaceutical companies (30%), government (27%), and unfunded (19%). Among 38 articles published between 2011 and 2014, the average cost per patient was: 13,388.2 USD, 16,655.5 CAD and 31,213 EUR.  Conclusions: The per patient cost of mental illness is substantial. Cost of mental illness studies from the patient’s perspective and from low-income regions are needed to enrich our understanding of the burden of mental illness. PMH33 Assessing The Economic Burden And Health Care Utilization Of Attention Deficit/Hyperactivity Disorder Among Medicaid Patients In The United States Zhang Q1, Zhao Y1, Keshishian A1, Xie L1, Yuce H2, Baser O3 Research, Ann Arbor, MI, USA, 2New York City College of Technology-CUNY and STATinMED Research, New York, NY, USA, 3Columbia University and STATinMED Research, New York, NY, USA


Objectives: To examine the economic burden and health care utilization of attention deficit/hyperactivity disorder (ADHD) in the US Medicaid population.  Methods: A case-control study was performed using US national Medicaid claims from 01JAN2008 through 31DEC2010. ADHD patients were identified using the International Classification of Diseases, 9th Revision, Clinical Modification diagnosis code: 314.01 from 01JAN2009 to 31DEC2009. The diagnosis date was designated as the index date. A control cohort of patients without an ADHD diagnosis was matched 1:1 with the case cohort of ADHD patients having the same age, region, gender, and index year. A random index date was chosen for the control cohort to reduce selection bias. Patients were required to have continuous health plan enrollment for at least 12 months pre- and post-index date. One-to-one propensity score matching (PSM) was performed to compare follow-up health care costs and utilizations between the two cohorts, adjusting for demographic characteristics and the baseline Charlson Comorbidity Index (CCI) score.  Results: Eligible patients (N= 98,965) were identified and included in each cohort. Compared with controls, ADHD patients tended to have higher CCI scores (0.42 vs. 0.31, p< 0.0001), and a higher proportion of comorbidities, such as congestive chronic pulmonary disease (13.97% vs. 9.79%), and depression (10.73% vs. 3.42%, p< 0.0001). After 1:1 PSM, 83,899 patients were matched, and the cohorts were well-balanced. A higher percentage of ADHD patients had health care utilization, including inpatient (6.85% vs. 3.64%), long-term care (LTC) (5.38% vs. 1.34%), pharmacy (94.70% vs. 63.27%), and outpatient visits (99.79% vs. 83.26%; p< 0.0001) than non-ADHD patients. Patients diagnosed with ADHD also incurred significantly higher costs, including LTC ($2,325 vs. $1,169), pharmacy ($3,061 vs. $1,272), outpatient ($9,384 vs. $6,368), ER ($113 vs. $73), and total health care costs ($15,500 vs. $9,498; p< 0.0001).  Conclusions: ADHD patients had a higher burden of illness compared to non-ADHD patients. PMH34 Time-To-Initiation, Healthcare Utilization, And Costs Of Treatment Of Attention Deficit Hyperactivity Disorder Among Texas Medicaid Preschoolers Singh RR1, Lawson KA2, Barner JC1, Richards KM1, Sasane R3, Wilson JP1 University of Texas at Austin, College of Pharmacy, Austin, TX, USA, 2The University of Texas at Austin, Austin, TX, USA, 3Novartis Pharmaceuticals, East Hanover, NJ, USA 1The

Objectives: The goal of the current study was to assess the time-to-initiation of treatment, healthcare utilization, and costs in preschoolers diagnosed with ADHD using the Texas Medicaid dataset.  Methods: The study sample included treatment-naïve patients between 2 and < 6 years of age at index enrolled in Texas Medicaid between January 01, 2008 and August 01, 2013, with: (1) at least one ADHD diagnosis based on ICD-9 codes (314.0x); (2) continuous enrollment in the index period; and (3) at least two ADHD medication claims or at least one psychotherapy visit associated with ADHD during the index period. The index date was defined as date of first ADHD diagnosis. The study population was sub-divided into three groups based on type of therapy in the follow-up period: pharmacotherapy only; psychotherapy only; and combination therapy. Descriptive and multivariate analyses were used to assess time-to-initiation, utilization, and costs among the treatment groups. SAS 9.3 was used for statistical analyses.  Results: Of the 10,877 preschoolers included in the study, 66.0% were initiated on pharmacotherapy, followed by 32.3% on psychotherapy, and 1.7% on combination therapy. The hazard rates (HR) for psychotherapy (HR =  1.827; p =  < 0.0001) and combination therapy (HR =  1.408; p =  < 0.0001) initiators were 82.7% and 40.8% higher, respectively, as compared to pharmacotherapy initiators. The combination therapy group had significantly higher healthcare utilization (p< 0.0001) in all resource categories except ADHD-related prescriptions, other mental health-related office-based, and inpatient visits. Similarly, medical, prescription, and total healthcare costs were also significantly higher in the combination therapy group (p< 0.0001) as compared to the pharmacotherapy