Economic impact of tobramycin in patients with cystic fibrosis in a managed care population
Abstract Objective: Guidelines recommend chronic use of tobramycin solution for inhalation (TSI) for cystic fibrosis (CF) patients with moderate-to-severe lung disease and persistent airway Pseudomonas aeruginosa. This study evaluated the economic impact of TSI in managed care CF patients. Methods:...
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| Veröffentlicht in: | Journal of medical economics 2011, Vol.14 (6), p.759-768 |
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| creator | Wertz, Debra A. Chang, Chun-Lan Stephenson, Judith J. Zhang, Jie Kuhn, Robert J. |
| description | Abstract
Objective:
Guidelines recommend chronic use of tobramycin solution for inhalation (TSI) for cystic fibrosis (CF) patients with moderate-to-severe lung disease and persistent airway Pseudomonas aeruginosa. This study evaluated the economic impact of TSI in managed care CF patients.
Methods:
Patients (0-64 years) with 2 CF medical claims between 01/01/04-03/31/09 were identified. For TSI users, the index date was the first TSI claim in the period; for non-users, a pseudo-index date was determined and randomly assigned by simulating the distribution of index dates of TSI users. Maximum sample size was obtained for patients with 3 months pre- and 12 months post-index eligibility. Users were categorized by number of TSI prescriptions filled during 12-month post-index period as low (1 fill), medium (2-3 fills) and high adherence ( 4 fills). Differences in per member per month (PMPM) costs pre-index to post-index were analyzed using paired t-tests.
Results:
A total of 388 TSI users (mean age 19 years, 48% female) and 444 non-users (mean age 30 years, 54% female) met study criteria. In users, total and CF-related PMPM costs decreased $959 (17%) and $113 (3%), respectively, after starting TSI. Among TSI users, CF-related inpatient PMPM costs decreased by $1171 (49%; p = 0.01), while CF-related prescription PMPM costs increased by $992 (p |
| doi_str_mv | 10.3111/13696998.2011.621004 |
| format | Article |
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Objective:
Guidelines recommend chronic use of tobramycin solution for inhalation (TSI) for cystic fibrosis (CF) patients with moderate-to-severe lung disease and persistent airway Pseudomonas aeruginosa. This study evaluated the economic impact of TSI in managed care CF patients.
Methods:
Patients (0-64 years) with 2 CF medical claims between 01/01/04-03/31/09 were identified. For TSI users, the index date was the first TSI claim in the period; for non-users, a pseudo-index date was determined and randomly assigned by simulating the distribution of index dates of TSI users. Maximum sample size was obtained for patients with 3 months pre- and 12 months post-index eligibility. Users were categorized by number of TSI prescriptions filled during 12-month post-index period as low (1 fill), medium (2-3 fills) and high adherence ( 4 fills). Differences in per member per month (PMPM) costs pre-index to post-index were analyzed using paired t-tests.
Results:
A total of 388 TSI users (mean age 19 years, 48% female) and 444 non-users (mean age 30 years, 54% female) met study criteria. In users, total and CF-related PMPM costs decreased $959 (17%) and $113 (3%), respectively, after starting TSI. Among TSI users, CF-related inpatient PMPM costs decreased by $1171 (49%; p = 0.01), while CF-related prescription PMPM costs increased by $992 (p < 0.01). CF-related inpatient PMPM costs decreased by $381 (38%; p = 0.16) for low and $1425 (50%; p = 0.21) for medium users and decreased by $1829 (51%; p = 0.02) for high users.
Limitations:
Limitations include use of administrative claims data, small sample size due to disease rarity, random assignment of pseudo-index date to non-users and differences in baseline characteristics between TSI users and non-users.
Conclusion:
All-cause and CF-related PMPM medical costs significantly decreased after TSI initiation. Among TSI users, total healthcare costs decreased, although not significantly, due to PMPM increases in prescription costs. A trend towards greater decrease in inpatient PMPM costs was observed with increasing TSI adherence.</description><identifier>ISSN: 1369-6998</identifier><identifier>EISSN: 1941-837X</identifier><identifier>DOI: 10.3111/13696998.2011.621004</identifier><identifier>PMID: 21942462</identifier><language>eng</language><publisher>England: Informa UK Ltd</publisher><subject>Administration, Inhalation ; Adolescent ; Adult ; Aged ; ANOVA, Analysis of Variance; CF, Cystic fibrosis; DCI, Deyo-Charlson comorbidity index; FDA, Food and Drug Administration; FEV ; Anti-Bacterial Agents - administration & dosage ; Anti-Bacterial Agents - economics ; Anti-Bacterial Agents - therapeutic use ; Child ; Child, Preschool ; Cost ; Costs and Cost Analysis ; Cystic fibrosis ; Cystic Fibrosis - complications ; Cystic Fibrosis - economics ; Expenditures ; Female ; forced expiratory volume in 1 second; GPI, Generic product identifier; HCPC, Healthcare Common Procedure Coding System; ICD-9-CM, International Classification of Diseases, 9th revision, Clinical Modification; PA, Pseudomonas aeruginosa; PMPM, Per member per month; TSI, Tobramycin solution for inhalation; US, United States ; Humans ; Infant ; Infant, Newborn ; Longitudinal Studies ; Male ; Managed Care Programs - statistics & numerical data ; Middle Aged ; Outcomes ; Pseudomonas Infections - etiology ; Pseudomonas Infections - prevention & control ; Retrospective Studies ; Tobramycin ; Tobramycin - administration & dosage ; Tobramycin - economics ; Tobramycin - therapeutic use ; Young Adult</subject><ispartof>Journal of medical economics, 2011, Vol.14 (6), p.759-768</ispartof><rights>2011 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted 2011</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3784-9cfd00dba81869d7ca0151735958c3a80519910fef811472adce696b9f1973d33</citedby><cites>FETCH-LOGICAL-c3784-9cfd00dba81869d7ca0151735958c3a80519910fef811472adce696b9f1973d33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,4028,27932,27933,27934</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21942462$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wertz, Debra A.</creatorcontrib><creatorcontrib>Chang, Chun-Lan</creatorcontrib><creatorcontrib>Stephenson, Judith J.</creatorcontrib><creatorcontrib>Zhang, Jie</creatorcontrib><creatorcontrib>Kuhn, Robert J.</creatorcontrib><title>Economic impact of tobramycin in patients with cystic fibrosis in a managed care population</title><title>Journal of medical economics</title><addtitle>J Med Econ</addtitle><description>Abstract
Objective:
Guidelines recommend chronic use of tobramycin solution for inhalation (TSI) for cystic fibrosis (CF) patients with moderate-to-severe lung disease and persistent airway Pseudomonas aeruginosa. This study evaluated the economic impact of TSI in managed care CF patients.
Methods:
Patients (0-64 years) with 2 CF medical claims between 01/01/04-03/31/09 were identified. For TSI users, the index date was the first TSI claim in the period; for non-users, a pseudo-index date was determined and randomly assigned by simulating the distribution of index dates of TSI users. Maximum sample size was obtained for patients with 3 months pre- and 12 months post-index eligibility. Users were categorized by number of TSI prescriptions filled during 12-month post-index period as low (1 fill), medium (2-3 fills) and high adherence ( 4 fills). Differences in per member per month (PMPM) costs pre-index to post-index were analyzed using paired t-tests.
Results:
A total of 388 TSI users (mean age 19 years, 48% female) and 444 non-users (mean age 30 years, 54% female) met study criteria. In users, total and CF-related PMPM costs decreased $959 (17%) and $113 (3%), respectively, after starting TSI. Among TSI users, CF-related inpatient PMPM costs decreased by $1171 (49%; p = 0.01), while CF-related prescription PMPM costs increased by $992 (p < 0.01). CF-related inpatient PMPM costs decreased by $381 (38%; p = 0.16) for low and $1425 (50%; p = 0.21) for medium users and decreased by $1829 (51%; p = 0.02) for high users.
Limitations:
Limitations include use of administrative claims data, small sample size due to disease rarity, random assignment of pseudo-index date to non-users and differences in baseline characteristics between TSI users and non-users.
Conclusion:
All-cause and CF-related PMPM medical costs significantly decreased after TSI initiation. Among TSI users, total healthcare costs decreased, although not significantly, due to PMPM increases in prescription costs. A trend towards greater decrease in inpatient PMPM costs was observed with increasing TSI adherence.</description><subject>Administration, Inhalation</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>ANOVA, Analysis of Variance; CF, Cystic fibrosis; DCI, Deyo-Charlson comorbidity index; FDA, Food and Drug Administration; FEV</subject><subject>Anti-Bacterial Agents - administration & dosage</subject><subject>Anti-Bacterial Agents - economics</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cost</subject><subject>Costs and Cost Analysis</subject><subject>Cystic fibrosis</subject><subject>Cystic Fibrosis - complications</subject><subject>Cystic Fibrosis - economics</subject><subject>Expenditures</subject><subject>Female</subject><subject>forced expiratory volume in 1 second; GPI, Generic product identifier; HCPC, Healthcare Common Procedure Coding System; ICD-9-CM, International Classification of Diseases, 9th revision, Clinical Modification; PA, Pseudomonas aeruginosa; PMPM, Per member per month; TSI, Tobramycin solution for inhalation; US, United States</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Managed Care Programs - statistics & numerical data</subject><subject>Middle Aged</subject><subject>Outcomes</subject><subject>Pseudomonas Infections - etiology</subject><subject>Pseudomonas Infections - prevention & control</subject><subject>Retrospective Studies</subject><subject>Tobramycin</subject><subject>Tobramycin - administration & dosage</subject><subject>Tobramycin - economics</subject><subject>Tobramycin - therapeutic use</subject><subject>Young Adult</subject><issn>1369-6998</issn><issn>1941-837X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMFq3DAQhk1paEKaNyhFt5680ViyLV1aSkjbQCCXBgo9iLEsdRVsyZVkwr59ZTYp5BIh0By-f2b0VdUHoDsGAJfAOtlJKXYNBdh1DVDK31RnIDnUgvW_3pa6IPXGnFYXKT3QchgD2sO76rQpYMO75qz6fa2DD7PTxM0L6kyCJTkMEeeDdp6Uu2B2xudEHl3eE31IucDWDTEklzYAyYwe_5iRaIyGLGFZp5IJ_n11YnFK5uLpPa_uv13_vPpR3959v7n6eltr1gteS21HSscBBYhOjr1GCi30rJWt0AwFbUFKoNZYAcD7Bkdtyu8HaUH2bGTsvPp07LvE8Hc1KavZJW2mCb0Ja1KSckoFb3kh-ZHUZfsUjVVLdDPGgwKqNrHqWazaxKqj2BL7-DRgHWYz_g89ayzAlyPgvA1xxscQp1FlPEwh2oheu1Tavz7i84sOe4NT3m9C1UNYoy_-Xt_xH58Ymkk</recordid><startdate>2011</startdate><enddate>2011</enddate><creator>Wertz, Debra A.</creator><creator>Chang, Chun-Lan</creator><creator>Stephenson, Judith J.</creator><creator>Zhang, Jie</creator><creator>Kuhn, Robert J.</creator><general>Informa UK Ltd</general><general>Taylor & Francis</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>2011</creationdate><title>Economic impact of tobramycin in patients with cystic fibrosis in a managed care population</title><author>Wertz, Debra A. ; Chang, Chun-Lan ; Stephenson, Judith J. ; Zhang, Jie ; Kuhn, Robert J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3784-9cfd00dba81869d7ca0151735958c3a80519910fef811472adce696b9f1973d33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Administration, Inhalation</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>ANOVA, Analysis of Variance; CF, Cystic fibrosis; DCI, Deyo-Charlson comorbidity index; FDA, Food and Drug Administration; FEV</topic><topic>Anti-Bacterial Agents - administration & dosage</topic><topic>Anti-Bacterial Agents - economics</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cost</topic><topic>Costs and Cost Analysis</topic><topic>Cystic fibrosis</topic><topic>Cystic Fibrosis - complications</topic><topic>Cystic Fibrosis - economics</topic><topic>Expenditures</topic><topic>Female</topic><topic>forced expiratory volume in 1 second; GPI, Generic product identifier; HCPC, Healthcare Common Procedure Coding System; ICD-9-CM, International Classification of Diseases, 9th revision, Clinical Modification; PA, Pseudomonas aeruginosa; PMPM, Per member per month; TSI, Tobramycin solution for inhalation; US, United States</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Managed Care Programs - statistics & numerical data</topic><topic>Middle Aged</topic><topic>Outcomes</topic><topic>Pseudomonas Infections - etiology</topic><topic>Pseudomonas Infections - prevention & control</topic><topic>Retrospective Studies</topic><topic>Tobramycin</topic><topic>Tobramycin - administration & dosage</topic><topic>Tobramycin - economics</topic><topic>Tobramycin - therapeutic use</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wertz, Debra A.</creatorcontrib><creatorcontrib>Chang, Chun-Lan</creatorcontrib><creatorcontrib>Stephenson, Judith J.</creatorcontrib><creatorcontrib>Zhang, Jie</creatorcontrib><creatorcontrib>Kuhn, Robert J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of medical economics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wertz, Debra A.</au><au>Chang, Chun-Lan</au><au>Stephenson, Judith J.</au><au>Zhang, Jie</au><au>Kuhn, Robert J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Economic impact of tobramycin in patients with cystic fibrosis in a managed care population</atitle><jtitle>Journal of medical economics</jtitle><addtitle>J Med Econ</addtitle><date>2011</date><risdate>2011</risdate><volume>14</volume><issue>6</issue><spage>759</spage><epage>768</epage><pages>759-768</pages><issn>1369-6998</issn><eissn>1941-837X</eissn><abstract>Abstract
Objective:
Guidelines recommend chronic use of tobramycin solution for inhalation (TSI) for cystic fibrosis (CF) patients with moderate-to-severe lung disease and persistent airway Pseudomonas aeruginosa. This study evaluated the economic impact of TSI in managed care CF patients.
Methods:
Patients (0-64 years) with 2 CF medical claims between 01/01/04-03/31/09 were identified. For TSI users, the index date was the first TSI claim in the period; for non-users, a pseudo-index date was determined and randomly assigned by simulating the distribution of index dates of TSI users. Maximum sample size was obtained for patients with 3 months pre- and 12 months post-index eligibility. Users were categorized by number of TSI prescriptions filled during 12-month post-index period as low (1 fill), medium (2-3 fills) and high adherence ( 4 fills). Differences in per member per month (PMPM) costs pre-index to post-index were analyzed using paired t-tests.
Results:
A total of 388 TSI users (mean age 19 years, 48% female) and 444 non-users (mean age 30 years, 54% female) met study criteria. In users, total and CF-related PMPM costs decreased $959 (17%) and $113 (3%), respectively, after starting TSI. Among TSI users, CF-related inpatient PMPM costs decreased by $1171 (49%; p = 0.01), while CF-related prescription PMPM costs increased by $992 (p < 0.01). CF-related inpatient PMPM costs decreased by $381 (38%; p = 0.16) for low and $1425 (50%; p = 0.21) for medium users and decreased by $1829 (51%; p = 0.02) for high users.
Limitations:
Limitations include use of administrative claims data, small sample size due to disease rarity, random assignment of pseudo-index date to non-users and differences in baseline characteristics between TSI users and non-users.
Conclusion:
All-cause and CF-related PMPM medical costs significantly decreased after TSI initiation. Among TSI users, total healthcare costs decreased, although not significantly, due to PMPM increases in prescription costs. A trend towards greater decrease in inpatient PMPM costs was observed with increasing TSI adherence.</abstract><cop>England</cop><pub>Informa UK Ltd</pub><pmid>21942462</pmid><doi>10.3111/13696998.2011.621004</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of medical economics, 2011, Vol.14 (6), p.759-768 |
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| subjects | Administration, Inhalation Adolescent Adult Aged ANOVA, Analysis of Variance CF, Cystic fibrosis DCI, Deyo-Charlson comorbidity index FDA, Food and Drug Administration FEV Anti-Bacterial Agents - administration & dosage Anti-Bacterial Agents - economics Anti-Bacterial Agents - therapeutic use Child Child, Preschool Cost Costs and Cost Analysis Cystic fibrosis Cystic Fibrosis - complications Cystic Fibrosis - economics Expenditures Female forced expiratory volume in 1 second GPI, Generic product identifier HCPC, Healthcare Common Procedure Coding System ICD-9-CM, International Classification of Diseases, 9th revision, Clinical Modification PA, Pseudomonas aeruginosa PMPM, Per member per month TSI, Tobramycin solution for inhalation US, United States Humans Infant Infant, Newborn Longitudinal Studies Male Managed Care Programs - statistics & numerical data Middle Aged Outcomes Pseudomonas Infections - etiology Pseudomonas Infections - prevention & control Retrospective Studies Tobramycin Tobramycin - administration & dosage Tobramycin - economics Tobramycin - therapeutic use Young Adult |
| title | Economic impact of tobramycin in patients with cystic fibrosis in a managed care population |
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