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Gari MH, Alsuhibani A, Alashgar A, Guo JJ. Utilization, reimbursement, and price trends for Hepatitis C virus medications in the US Medicaid programs: 2001-2021. Explor Res Clin Soc Pharm 2023; 12:100383. [PMID: 38145237 PMCID: PMC10746553 DOI: 10.1016/j.rcsop.2023.100383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 11/10/2023] [Accepted: 11/25/2023] [Indexed: 12/26/2023] Open
Abstract
Background Hepatitis C Virus (HCV) remains a challenging health problem worldwide, with increasing incidence despite being curable with Direct Acting Antiviral (DAA) agents. Objective This study aimed to describe the utilization, reimbursement, and price trends of HCV treatments and evaluate the influence of treatment guidelines and policies. Methods A retrospective, descriptive drug utilization study conducted using the outpatient pharmacy data extracted from the Centers for Medicaid and Medicare Services State Drug Utilization Data between 2001 and 2021. All HCV treatments approved in the US were included, conventional therapy (CT), and DAA agents. The annual secular trends were calculated for each medication's total number of prescriptions, reimbursements, and prices. The average reimbursement per prescription was calculated and utilized as a proxy of prices. The HCV treatment guideline and policies and legislation were evaluated overtime to measure the impact on the trends. Results Despite CT having a higher total utilization, DAA agents commanded significantly greater reimbursements, with 4.1 billion USD for CT and 19.45 billion USD for DAA agents. CT utilization increased rapidly and dominated the market until 2011, peaking at 379,696 prescriptions in 2003 but declining afterward. DAA agents' utilization increased rapidly in their first year: i.e., sofosbuvir reached 50,377 prescriptions with 1.3 billion USD in 2014, while ledipasvir/sofosbuvir reached 79,387 prescriptions with 2 billion USD in 2015. The average price per prescription was high for the DAA agents, like 24,992 USD for sofosbuvir and 22,787 USD for ledipasvir/sofosbuvir, compared to CT medications ribavirin, around 500 USD, and pegINF, around 3000 USD. The new DAA agents replaced CT, and initiating market competition among DAA agents. Conclusion The introduction of multiple DAA agents slightly changed their prescription prices but remained high during the study period. The recent increase in HCV incidence cases indicates accessibility issues for costly and effective DAA agents, with treatment guidelines and policies playing a critical role in shaping these trends.
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Affiliation(s)
- Musaab H. Gari
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH 45267, USA
| | - Abdulrahman Alsuhibani
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH 45267, USA
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Saudi Arabia
| | - Amin Alashgar
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH 45267, USA
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Saudi Arabia
| | - Jeff J. Guo
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH 45267, USA
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Alsuhibani A, Thompson JR, Wigle PR, Guo JJ, Lin AC, Rao MB, Hincapie AL. Metabolic and Bariatric Surgery Utilization Trends in the United States: Evidence From 2012 to 2021 National Electronic Medical Records Network. Ann Surg Open 2023; 4:e317. [PMID: 38144499 PMCID: PMC10735086 DOI: 10.1097/as9.0000000000000317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/25/2023] [Indexed: 12/26/2023] Open
Abstract
Background Bariatric surgery has evolved over the past 2 decades yet assessing trends of bariatric surgery utilization in the growing eligible population is lacking. Aim This study aimed to update the trends in bariatric surgery utilization, changes in types of procedures performed, and the characteristics of patients who underwent bariatric surgery in the United States, using real-world data. Method This retrospective descriptive observational study was conducted using the TriNetX, a federated electronic medical records network from 2012 to 2021, for adult patients 18 years old or older who had bariatric surgery. Descriptive statistical analysis was conducted to assess patients' demographics and characteristics. Annual secular trend analyses were conducted for the annual rate of bariatric surgery, and the specific procedural types and proportions of laparoscopic surgeries. Results A steady increase in the number of procedures performed in the United States over the first 6 years of the study, a plateau for the following 2 years, and then a decline in 2020 and 2021 (during the coronavirus disease 2019 pandemic). The annual rate of bariatric surgery was lowest in 2012 at 59.2 and highest in 2018 at 79.6 surgeries per 100,000 adults. During the study period, 96.2% to 98.8% of procedures performed annually were conducted laparoscopically as opposed to the open technique. Beginning in 2012, the Roux-en-Y gastric bypass (RYGB) procedure fell to represent only 17.1% of cases in 2018, along with a sharp decline in the adjustable gastric band (AGB) procedure, replaced by a sharp increase in the sleeve gastrectomy (SG) procedure to represent over 74% of cases in 2018. Conclusions Bariatric surgery utilization in the United States showed a moderate decline in the number of RYGB procedures, which was offset by a substantial increase in the number of SG procedures and a precipitous drop in the annual number of AGB procedures.
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Affiliation(s)
- Abdulrahman Alsuhibani
- From the Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Saudi Arabia
- Department of Health outcome, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH
| | - Jonathan R. Thompson
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Patricia R. Wigle
- Department of Health outcome, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH
| | - Jeff Jianfei Guo
- Department of Health outcome, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH
| | - Alex C. Lin
- Department of Health outcome, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH
| | - Marepalli B. Rao
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Ana L. Hincapie
- Department of Health outcome, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH
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Alrasheed M, Alsuhibani A, Balkhi B, Guo JJ. Drug Expenditure, Price, and Utilization in US Medicaid: A Trend Analysis for New Multiple Myeloma Medications from 2016 to 2022. Healthcare (Basel) 2023; 11:2265. [PMID: 37628464 PMCID: PMC10454759 DOI: 10.3390/healthcare11162265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/06/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION Multiple myeloma (MM) is the most common plasma cell tumor type. In late 2015, the FDA approved three new medications for MM. These medications were ixazomib, daratumumab, and elotuzumab. However, their utilization, reimbursement, and price in the Medicaid program have not been analyzed before. METHODS A retrospective drug utilization study using the national Medicaid pharmacy claims data from 2016 to 2022 in the US. The primary metrics of analysis were utilization (number of prescriptions), reimbursement (total spending), and price (reimbursement per prescription). RESULTS The overall Medicaid utilization of MM medications increased from 1671 prescriptions in 2016 to 34,583 prescriptions in 2022 (1970% increase). Moreover, the overall Medicaid reimbursement for the new MM medications increased from USD 9,250,000 in 2016 to over USD 214,449,000 in 2022 (2218% increase). Daratumumab had much higher utilization, reimbursement, and market shares than its competitors. Ixazomib was the most expensive medication compared to daratumumab and elotuzumab. CONCLUSION The results of this study demonstrate that CMS utilization and spending on MM medications have significantly grown since 2016. Daratumumab has by far the highest utilization, spending, and market share. The utilization of and spending on specific pharmaceuticals are clearly impacted by policy and clinical guideline recommendations.
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Affiliation(s)
- Marwan Alrasheed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia;
| | - Abdulrahman Alsuhibani
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH 45267, USA; (A.A.); (J.J.G.)
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah 56434, Saudi Arabia
| | - Bander Balkhi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia;
| | - Jeff Jianfei Guo
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH 45267, USA; (A.A.); (J.J.G.)
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Alsuhibani A, Alrasheed M, Gari M, Hincapie AL, Guo JJ. Descriptive analysis of reported adverse events associated with anti-obesity medications using FDA Adverse Event Reporting System (FAERS) databases 2013-2020. Int J Clin Pharm 2021; 44:172-179. [PMID: 34564826 DOI: 10.1007/s11096-021-01330-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/14/2021] [Indexed: 11/25/2022]
Abstract
Background Obesity is a globally growing health problem, and its treatment has been challenging. The use of anti-obesity medications (AOMs) has been associated with severe adverse events (AEs). Several AOMs have been withdrawn from the market owing to documented AEs. Aim To describe, estimate and characterize the frequency of AEs attributable to the use of the AOMs, and investigate previously unreported potential AEs associated with AOMs. Method Using the US FDA Adverse Event Reporting System (FAERS) between January 2013 and June 2020, a retrospective, descriptive analysis was conducted to analyze all major reported AEs and outcomes including death, life-threatening, hospitalization, disability, and required intervention or congenital anomaly. The total numbers of AEs reports, cases, adverse reactions and outcomes were calculated for each medication. Results A total of 18,675 unique AEs reports associated with AOMs used for 15,143 patients. The mean age was 49.8 years [SD 1.83], while most patients were female adults (73.4%). The most frequently reported AEs were nausea and vomiting, followed by dizziness and headache, drug ineffectiveness, cardiovascular diseases, and kidney complications. There were 21,229 unique outcomes, including 1039 deaths (fatality ratio of 4.9% of all analyzed reports), 1613 (7.6%) life-threatening events, 7426 (35%) hospitalizations, and 1249 (5.9%) disability cases. Phentermine/topiramate fatal cases represent 6% of the overall medication's reported AEs. Cardiovascular AEs represented 31%, 23%, and 22% of phentermine, liraglutide, and phentermine/topiramate total AEs, respectively. Conclusion The analysis of FAERS database revealed numerous serious AEs associated with AOMs. These AEs can lead to serious cardiovascular and kidney complications. It is necessary to continue and systematically monitor safety of AOMs' to optimize patient anti-obesity therapy.
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Affiliation(s)
- Abdulrahman Alsuhibani
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, 45267, USA.
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah, Saudi Arabia.
| | - Marwan Alrasheed
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, 45267, USA
- Department of Clinical Pharmacy, King Saud University College of Pharmacy, Riyadh, Saudi Arabia
| | - Musaab Gari
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, 45267, USA
| | - Ana L Hincapie
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, 45267, USA
| | - Jeff Jianfei Guo
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, 45267, USA
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Vouri SM, Bhagwandass H, Valdes IL, Al-Bahou J, Alsuhibani A, Friedman J. Changes in utilization of immediate-release, extended-release, and liquid formulation medications relative to bariatric surgery: a segmented regression analysis. Surg Obes Relat Dis 2021; 17:1089-1094. [PMID: 33795201 DOI: 10.1016/j.soard.2021.02.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/12/2021] [Accepted: 02/20/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Changes in gut anatomy following bariatric surgery impacts medication absorption, often requiring changes in medication formulations. OBJECTIVES To assess changes in utilization of extended-release (ER), immediate-release (IR), and liquid formulations 360 days before and after bariatric surgery. SETTING Large U.S. administrative claims database of privately insured beneficiaries, January 2005 through December 2018. METHODS We included patients aged ≥18 years with 360 days of continuous enrollment before and after date of bariatric surgery (Roux-en-Y gastric bypass [RYGB] or sleeve gastrectomy [SG]). The proportion of each formulation (ER, IR, or liquid) of oral prescription medications filled during the study period were assessed in twelve 30-day windows before and after bariatric surgery and stratified by bariatric surgery type. Segmented regression analysis was used to assess filled medication categorized by formulation before and after bariatric surgery overall and RYGB relative to SG. RESULTS Among 122,866 included patients, there were increases in the proportion of patients on each formulation before and after surgery attributed to proton pump inhibitors, opioids, antiemetics, and ursodiol. After removing these acutely used medications, we found a 40% immediate reduction in patients on ER medications (P < .0001), 15% immediate reduction in patients on IR medications (P < .0001), and a nonsignificant increase in patients on liquid formulations (P = .1340). CONCLUSION Despite reductions in ER formulations, many patients continued on this formulation which may potentially contribute to poor outcomes.
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Affiliation(s)
- Scott Martin Vouri
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida; Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida.
| | - Hemita Bhagwandass
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Ivelisse L Valdes
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Julie Al-Bahou
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Abdulrahman Alsuhibani
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida; Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Saudi Arabia
| | - Jeffrey Friedman
- Department of Surgery, College of Medicine, University of Florida, Gainesville, Florida
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Alsuhibani A, Albogami Y, Diaby V, Friedman J, Vouri SM. Evaluation of statin discontinuation stratified by primary versus secondary prevention following bariatric surgery: a retrospective cohort study. Surg Obes Relat Dis 2021; 17:939-946. [PMID: 33648887 DOI: 10.1016/j.soard.2021.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/18/2020] [Accepted: 01/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Bariatric surgery leads to an improvement in hyperlipidemia and a subsequent decline in the use of hyperlipidemia-related medications, including statins. In patients with a history of atherosclerotic cardiovascular disease (ASCVD), it is recommended to continue statins; however, it is unknown whether there is a differential risk for statin discontinuation in patients with and without a history of ASCVD. OBJECTIVES To estimate the rates and factors associated with statin discontinuation following bariatric surgery. SETTING Large U.S. administrative claims database of privately insured beneficiaries, January 2005 through December 2017. METHODS We identified patients aged ≥19 years who were statin users at the time of bariatric surgery. Patients were stratified into primary prevention and secondary prevention (patients with a history of ASCVD) groups. Time to statin discontinuation was defined as the first 90-day gap after exhausting the last day's supply of the last statin prescription. Factors associated with statin discontinuation were assessed using the Cox proportional hazards regression model. RESULTS We identified 19,332 statin users at the time of bariatric surgery, of whom 84% (16,221) used statins for primary prevention. At 6 months, 62% and 53% of patients in the primary and the secondary prevention treatment groups, respectively, discontinued statin use. Patients in the primary prevention treatment group were 18% more likely to discontinue statin therapy compared with the patients in the secondary prevention treatment group (hazard ratio, 1.18; 95% confidence interval, 1.13-1.24) according to a multivariable analysis. CONCLUSIONS Our findings suggest that the rate of discontinuation of statin therapy after bariatric surgery was more pronounced in the primary versus secondary prevention treatment group.
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Affiliation(s)
- Abdulrahman Alsuhibani
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida; Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah, Saudi Arabia; Department of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio
| | - Yasser Albogami
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida; Department of Clinical Pharmacy, King Saud University College of Pharmacy, Riyadh, Saudi Arabia; Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Vakaramoko Diaby
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida; Center for Drug Evaluation and Safety-University of Florida, Gainesville, Florida
| | - Jeffrey Friedman
- Department of Surgery, College of Medicine, Gainesville, Florida
| | - Scott Martin Vouri
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida; Center for Drug Evaluation and Safety-University of Florida, Gainesville, Florida.
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