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Curran J, Wang Y, Kang SY, Xuan A, Anderson G, Bai G, Caleb Alexander G. Characteristics of Prescription Drug Fills Using Pharmacy-Pharmacy Benefit Manager Discount Programs: The "GoodRx" Model. Value Health 2024; 27:35-42. [PMID: 37879400 DOI: 10.1016/j.jval.2023.10.005] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/27/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVES This study aimed to characterize products using pharmacy-pharmacy benefit manager (PBM) discounts and to estimate the association among such discounts, prescription utilization, and out-of-pocket costs. METHODS This is a retrospective cohort study using IQVIA's Formulary Impact Analyzer, which contains anonymized, individual-level pharmacy claims representing US retail pharmacy transactions. We focused on 20 products with the greatest number of transactions using a pharmacy-PBM discount. Our unit of analysis was a treatment episode, defined as the length of time from an incident fill to no continuous use for 60 consecutive days after allowing for indefinite stockpiling. Outcome measures included products with greatest pharmacy-PBM discount use, characteristics of treatment episodes, and out-of-pocket costs with and without pharmacy-PBM discount. RESULTS Across all products, 3.82% of transactions and 7.69% of treatment episodes were accompanied by a pharmacy-PBM discount. Commonly discounted products included generic treatments for chronic disease (lisinopril, levothyroxine, metformin) and neuropsychiatric conditions (alprazolam, amphetamine, buprenorphine, hydrocodone). The median postdiscount out-of-pocket cost was >2.5-fold higher during treatment episodes with a discount than those without ($15.15, interquartile range [IQR] $8.53-32.00, vs $5.88, IQR $1.40-15.00). Median treatment episode duration was 249 days (IQR 132-418) with discount use compared with 236 days (IQR 121-396) without discount use, although treatment episodes that began with a discount had fewer transactions per treatment episode and were shorter (median 212 days, IQR 114-360) than those that did not (313 days, IQR 178-500). CONCLUSIONS Pharmacy-PBM discounts may foster market competition and improve access for under- and uninsured individuals; however, these programs may not generate savings for many insured individuals.
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Affiliation(s)
- Jill Curran
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yuchen Wang
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins Carey Business School, Baltimore, MD, USA
| | - So-Yeon Kang
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Health Management and Policy, Georgetown University School of Health, Washington, DC, USA
| | - Andrew Xuan
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gerard Anderson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ge Bai
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins Carey Business School, Baltimore, MD, USA
| | - G Caleb Alexander
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, USA.
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Baumgartner PC, Vrijens B, Allemann S, Hersberger KE, Arnet I. Delta T, a Useful Indicator for Pharmacy Dispensing Data to Monitor Medication Adherence. Pharmaceutics 2022; 14:103. [PMID: 35056999 DOI: 10.3390/pharmaceutics14010103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Calculating patients' medication availability from dispensing or refill data is a common method to estimate adherence. The most often used measures, such as the medication possession ratio (MPR), average medication supplies over an arbitrary period. Averaging masks the variability of refill behavior over time. GOAL To derive a new absolute adherence estimate from dispensing data. METHOD Dispensing histories of patients with 19 refills of direct oral anticoagulants (DOAC) between 1 January 2008 and 31 December 2017 were extracted from 39 community pharmacies in Switzerland. The difference between the calculated and effective refill day (ΔT) was determined for each refill event. We graphed ΔT and its dichotomized version (dΔT) against the MPR, calculated mean ΔT and mean dΔT per refill, and applied cluster analysis. RESULTS We characterized 2204 refill events from 116 DOAC patients. MPR was high (0.975 ± 0.129) and showed a positive correlation with mean ΔT. Refills occurred on average 17.8 ± 27.9 days "too early", with a mean of 75.8 ± 20.2 refills being "on time". Four refill behavior patterns were identified including constant gaps within or at the end of the observation period, which were critical. CONCLUSION We introduce a new absolute adherence estimate ΔT that characterizes every refill event and shows that the refill behavior of DOAC patients is dynamic.
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Enners S, Gradl G, Kieble M, Böhm M, Laufs U, Schulz M. Utilization of drugs with reports on potential efficacy or harm on COVID-19 before, during, and after the first pandemic wave. Pharmacoepidemiol Drug Saf 2021; 30:1493-1503. [PMID: 34245078 PMCID: PMC8441787 DOI: 10.1002/pds.5324] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/14/2021] [Accepted: 07/02/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE Conflicting information on potential benefits of drugs as well as reports on hypothetical harm of commonly used drugs in COVID-19 treatment have challenged clinicians and healthcare systems. We analyzed the change in ambulatory drug utilization before, during, and after the first wave of the pandemic in 2020. METHODS We explored dispensing data of nearly 19 000 pharmacies at the expense of the statutory health insurance funds covering 88% of Germany's population. We analyzed utilization of publicly discussed drugs with conflicting information. Drug utilization as number of packages dispensed per week from January to June 2020, reflecting 314 million claims, was compared with 2019. RESULTS Utilization of hydroxychloroquine increased +110% during March 2020 and then slightly decreased until week April 13-19. Renin-angiotensin-aldosterone system inhibitors and simvastatin/atorvastatin increased, +78% and +74%, respectively, and subsequently decreased below 2019 levels. Utilization of azithromycin and all systemic antibiotics decreased continuously from March 2-8 until June to levels considerably lower compared to 2019 (June 22-28: azithromycin: -55%, all systemic antibiotics: -27%). Pneumococcal vaccines utilization initially increased +373%, followed by supply shortages. Paracetamol utilization showed an initial increase of +111%, mainly caused by an increase of over-the-counter dispensings. CONCLUSIONS Apart from the pandemic itself, the data suggest that dissemination of misinformation and unsound speculations as well as supply shortages influenced drug prescribing, utilization, and purchasing behavior. The findings can inform post-pandemic policy to prevent unfounded over- and underprescribing and off-label use as well as drug shortages during a public health crisis.
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Affiliation(s)
- Salka Enners
- German Institute for Drug Use Evaluation (DAPI)BerlinGermany
| | - Gabriele Gradl
- German Institute for Drug Use Evaluation (DAPI)BerlinGermany
| | - Marita Kieble
- German Institute for Drug Use Evaluation (DAPI)BerlinGermany
| | - Michael Böhm
- Department of Internal Medicine III – Cardiology, Angiology and Intensive Care MedicineSaarland University Medical CenterHomburgGermany
| | - Ulrich Laufs
- Department of CardiologyUniversity Hospital LeipzigLeipzigGermany
| | - Martin Schulz
- German Institute for Drug Use Evaluation (DAPI)BerlinGermany
- Drug Commission of German Pharmacists (AMK)BerlinGermany
- Institute of PharmacyFreie Universität BerlinBerlinGermany
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4
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Khan SR, Heller DA, Latty LL, LaSure M, Brown TV. A Retrospective Study of Psychotropic Drug Use and Prescription Opioid Initiation Among Older Adults. Popul Health Manag 2021; 25:126-133. [PMID: 34402688 DOI: 10.1089/pop.2021.0129] [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] [Indexed: 11/13/2022] Open
Abstract
Individuals with mental health problems may be more vulnerable to using prescription opioids than their counterparts. Therefore, the main objective of this study was to assess the initiation of prescription opioids in older adults who used psychotropic drugs compared with those who did not. The authors used a retrospective cohort design and included a sample of older adults enrolled in Pennsylvania's Pharmaceutical Assistance Contract for the Elderly program who did not use prescription opioids in 2013. Using pharmacy claims, patients who used anxiolytics/sedatives/hypnotics (n = 13,512) or antidepressants (n = 17,492) between October and December 2013 were identified and compared with those who did not use anxiolytics/sedatives/hypnotics (n = 114,091) or antidepressants (n = 110,111) during that period, to determine the incidence of prescription opioid use in 2014. Chi-square tests and multivariate logistic regressions were performed for analyses. Compared with patients who did not use anxiolytics/sedatives/hypnotics, those who used were more likely to initiate prescription opioids (15.0% versus 22.0%, P < .0001). Similarly, compared with patients who did not use antidepressants, those who used were more likely to initiate prescription opioids (14.7% versus 21.9%, P < .0001). Multivariate logistic regression indicated that the odds of prescription opioid initiation increased with anxiolytic/sedative/hypnotic use by 44% (AOR = 1.44; P < .0001) and antidepressant use by 48% (AOR = 1.48; P < .0001) among older adults after adjusting for potential confounding variables. Results showed that prescription opioid initiation is associated with prior anxiolytic/sedative/hypnotic or antidepressant use among older adults. Patients with mental health problems should also be queried about pain experiences for effective treatment.
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Affiliation(s)
- Shivani R Khan
- Magellan Rx Management/PACE, Harrisburg, Pennsylvania, USA
| | - Debra A Heller
- Magellan Rx Management/PACE, Harrisburg, Pennsylvania, USA
| | - Leroy L Latty
- Magellan Rx Management/PACE, Harrisburg, Pennsylvania, USA
| | | | - Theresa V Brown
- Pennsylvania Department of Aging, Bureau of Pharmaceutical Assistance, Harrisburg, Pennsylvania, USA
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Lentine KL, Lam NN, Caliskan Y, Alhamad T, Xiao H, Schnitzler MA, Chang SH, Axelrod D, Segev DL, McAdams-DeMarco M, Kasiske BL, Hess GP, Brennan DC. Hydroxychloroquine and maintenance immunosuppression use in kidney transplant recipients: Analysis of linked US registry and claims data. Clin Transplant 2020; 34:e14118. [PMID: 33048372 DOI: 10.1111/ctr.14118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/23/2020] [Revised: 09/05/2020] [Accepted: 10/08/2020] [Indexed: 01/01/2023]
Abstract
Hydroxychloroquine (HCQ) is an antimalarial drug with immunomodulatory effects used to treat systemic lupus erythematosus (SLE) and scleroderma. The antiviral effects of HCQ have raised attention in the context of the COVID-19 pandemic, although safety is controversial. We examined linkages of national transplant registry data with pharmaceutical claims and Medicare billing claims to study HCQ use among Medicare-insured kidney transplant recipients with SLE or scleroderma (2008-2017; N = 1820). We compared three groups based on immunosuppression regimen 7 months-to-1 year post transplant: (a) tacrolimus (Tac) + mycophenolic acid (MPA) + prednisone (Pred) (referent group, 77.7%); (b) Tac + MPA + Pred + HCQ (16.5%); or (c) other immunosuppression + HCQ (5.7%). Compared to the referent group, recipients treated with other immunosuppression + HCQ had a 2-fold increased risk of abnormal ECG or QT prolongation (18.9% vs. 10.7%; aHR,1.12 1.963.42 , p = .02) and ventricular arrhythmias (15.2% vs. 11.4%; aHR,1.00 1.813.29 , p = .05) in the >1-to-3 years post-transplant. Tac + MPA + Pred + HCQ was associated with increased risk of ventricular arrhythmias (13.5% vs. 11.4%; aHR,1.02 1.542.31 , p = .04) and pancytopenia (35.9% vs. 31.4%; aHR,1.03 1.311.68 , p = .03) compared to triple immunosuppression without HCQ. However, HCQ-containing regimens were not associated with an increased risk of death or graft failure. HCQ may be used safely in selected kidney transplant recipients in addition to their maintenance immunosuppression, although attention to arrhythmias is warranted.
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Affiliation(s)
- Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University, St. Louis, MO, USA
| | - Ngan N Lam
- University of Calgary, Calgary, AB, Canada
| | - Yasar Caliskan
- Center for Abdominal Transplantation, Saint Louis University, St. Louis, MO, USA
| | - Tarek Alhamad
- Washington University in Saint Louis, St. Louis, MO, USA
| | - Huiling Xiao
- Center for Abdominal Transplantation, Saint Louis University, St. Louis, MO, USA
| | - Mark A Schnitzler
- Center for Abdominal Transplantation, Saint Louis University, St. Louis, MO, USA
| | - Su-Hsin Chang
- Washington University in Saint Louis, St. Louis, MO, USA
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Russo V, Orlando V, Monetti VM, Galimberti F, Casula M, Olmastroni E, Tragni E, Menditto E. Geographical Variation in Medication Prescriptions: A Multiregional Drug-Utilization Study. Front Pharmacol 2020; 11:418. [PMID: 32536861 PMCID: PMC7269055 DOI: 10.3389/fphar.2020.00418] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/19/2020] [Indexed: 11/13/2022] Open
Abstract
Background Studies have emphasized the importance of geographical factors and general practitioner (GP) characteristics in influencing drug prescriptions. Objectives To: (i) ascertain the prevalence rate (PR) of use of drugs in six therapeutic categories used for chronic conditions; (ii) assess how geographical characteristics and GP characteristics may influence drug prescribing. Methods This study is part of the EDU.RE.DRUG Project, a national collaborative project founded by Italian Medicine Agency (AIFA). Cross-sectional analyses were undertaken employing the pharmacy-claim databases of four local health units (LHUs) located in two Italian regions: Lombardy and Campania. Six drug categories were evaluated: proton-pump inhibitors; antibiotics; respiratory-system drugs; statins; agents acting on the renin−angiotensin system; psychoanaleptic drugs. The PR was estimated according to drug categories at the LHU level. A linear multivariate regression analysis was undertaken to evaluate the association between the PR and geographical area, age and sex of GPs, number of patients, and percentage of patients aged >65 per GP. Results LHUs in Campania showed a PR that was significantly higher than that in Lombardy. Antibiotics showed the highest PR in all the LHUs assessed, ranging from 32.5% in Lecco (Lombardy) to 59.7% in Naples-2 (Campania). Multivariate linear regression analysis confirmed the association of the PR with geographical area for all drug categories. Being located in Campania increased the possibility of receiving a drug prescription from the categories considered, with estimates more marked for antibiotics, proton-pump-inhibitors, and respiratory-system drugs. Conclusions This study provides information about the PR of medications used for treating common and costly conditions in Italy and highlighted a significant geographical variation. These insights could help to develop area-specific strategies to optimize prescribing behavior.
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Affiliation(s)
- Veronica Russo
- Department of Pharmacy, University of Naples Federico II, Naples, Italy.,CIRFF-Center of Pharmacoeconomics and Drug Utilization Research, University of Naples Federico II, Naples, Italy
| | - Valentina Orlando
- Department of Pharmacy, University of Naples Federico II, Naples, Italy.,CIRFF-Center of Pharmacoeconomics and Drug Utilization Research, University of Naples Federico II, Naples, Italy
| | - Valeria Marina Monetti
- Department of Pharmacy, University of Naples Federico II, Naples, Italy.,CIRFF-Center of Pharmacoeconomics and Drug Utilization Research, University of Naples Federico II, Naples, Italy
| | - Federica Galimberti
- Centro Interuniversitario di Epidemiologia e Farmacologia Preventiva, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy
| | - Manuela Casula
- Centro Interuniversitario di Epidemiologia e Farmacologia Preventiva, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy.,MultiMedica (IRCCS), Milan, Italy
| | - Elena Olmastroni
- Centro Interuniversitario di Epidemiologia e Farmacologia Preventiva, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy
| | - Elena Tragni
- Centro Interuniversitario di Epidemiologia e Farmacologia Preventiva, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy
| | - Enrica Menditto
- Department of Pharmacy, University of Naples Federico II, Naples, Italy.,CIRFF-Center of Pharmacoeconomics and Drug Utilization Research, University of Naples Federico II, Naples, Italy
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Lentine KL, Koraishy FM, Sarabu N, Naik AS, Lam NN, Garg AX, Axelrod D, Zhang Z, Hess GP, Kasiske BL, Segev DL, Henderson ML, Massie AB, Holscher CM, Schnitzler MA. Associations of obesity with antidiabetic medication use after living kidney donation: An analysis of linked national registry and pharmacy fill records. Clin Transplant 2019; 33:e13696. [PMID: 31421057 PMCID: PMC7153560 DOI: 10.1111/ctr.13696] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/23/2019] [Accepted: 08/05/2019] [Indexed: 12/19/2022]
Abstract
We examined a novel linkage of national US donor registry data with records from a pharmacy claims warehouse (2007-2016) to examine associations (adjusted hazard ratio, LCL aHRUCL ) of post-donation fills of antidiabetic medications (ADM, insulin or non-insulin agents) with body mass index (BMI) at donation and other demographic and clinical factors. In 28 515 living kidney donors (LKDs), incidence of ADM use at 9 years rose in a graded manner with higher baseline BMI: underweight, 0.9%; normal weight, 2.1%; overweight, 3.5%; obese, 8.5%. Obesity was associated with higher risk of ADM use compared with normal BMI (aHR, 3.36 4.596.27 ). Metformin was the most commonly used ADM and was filled more often by obese than by normal weight donors (9-year incidence, 6.87% vs 1.85%, aHR, 3.55 5.007.04 ). Insulin use was uncommon and did not differ significantly by BMI. Among a subgroup with BMI data at the 1-year post-donation anniversary (n = 19 528), compared with stable BMI, BMI increase >0.5 kg/m2 by year 1 was associated with increased risk of subsequent ADM use (aHR, 1.03 1.482.14, P = .04). While this study did not assess the impact of donation on the development of obesity, these data support that among LKD, obesity is a strong correlate of ADM use.
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Affiliation(s)
- Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Farrukh M Koraishy
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Nagaraju Sarabu
- Division of Nephrology, Department of Medicine, University Hospitals Cleveland Medical center, Cleveland, OH, USA
| | - Abhijit S Naik
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ngan N Lam
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Amit X Garg
- Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
| | - David Axelrod
- University of Iowa Transplant Institute, University of Iowa School of Medicine, Iowa City, IA, USA
| | - Zidong Zhang
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Gregory P Hess
- Drexel College of Medicine, Drexel University, Philadelphia, PA, USA
| | - Bertram L Kasiske
- Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Dorry L Segev
- Division of Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Macey L Henderson
- Division of Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Allan B Massie
- Division of Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Courtenay M Holscher
- Division of Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Mark A Schnitzler
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
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8
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Vest LS, Koraishy FM, Zhang Z, Lam NN, Schnitzler MA, Dharnidharka VR, Axelrod D, Naik AS, Alhamad TA, Kasiske BL, Hess GP, Lentine KL. Metformin use in the first year after kidney transplant, correlates, and associated outcomes in diabetic transplant recipients: A retrospective analysis of integrated registry and pharmacy claims data. Clin Transplant 2018; 32:e13302. [PMID: 29851159 PMCID: PMC6122956 DOI: 10.1111/ctr.13302] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2018] [Indexed: 12/18/2022]
Abstract
While guidelines support metformin as a therapeutic option for diabetic patients with mild-to-moderate renal insufficiency, the frequency and outcomes of metformin use in kidney transplant recipients are not well described. We integrated national U.S. transplant registry data with records from a large pharmaceutical claims clearinghouse (2008-2015). Associations (adjusted hazard ratio, 95% LCL aHR95% UCL ) of diabetes regimens (with and excluding metformin) in the first year post-transplant with patient and graft survival over the subsequent year were quantified by multivariate Cox regression, adjusted for recipient, donor, and transplant factors and propensity for metformin use. Among 14 144 recipients with pretransplant type 2 diabetes mellitus, 4.7% filled metformin in the first year post-transplant; most also received diabetes comedications. Compared to those who received insulin-based regimens without metformin, patients who received metformin were more likely to be female, have higher estimated glomerular filtration rates, and have undergone transplant more recently. Metformin-based regimens were associated with significantly lower adjusted all-cause (aHR 0.18 0.410.91 ), malignancy-related (aHR 0.45 0.450.99 ), and infection-related (aHR 0.12 0.320.85 ) mortality, and nonsignificant trends toward lower cardiovascular mortality, graft failure, and acute rejection. No evidence of increased adverse graft or patient outcomes was noted. Use of metformin-based diabetes treatment regimens may be safe in carefully selected kidney transplant recipients.
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Affiliation(s)
- L S Vest
- Saint Louis University, St. Louis, MO, USA
| | | | - Z Zhang
- Saint Louis University, St. Louis, MO, USA
| | - N N Lam
- University of Alberta, Edmonton, AB, Canada
| | | | | | | | - A S Naik
- Univ Michigan, Ann Arbor, MI, USA
| | | | | | - G P Hess
- Symphony Health, Conshohocken, PN, USA
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9
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Zhao JP, Sheehy O, Gorgui J, Bérard A. Can We Rely on Pharmacy Claims Databases to Ascertain Maternal Use of Medications during Pregnancy? Birth Defects Res 2017; 109:423-431. [PMID: 28398706 DOI: 10.1002/bdra.23604] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/25/2016] [Accepted: 11/23/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Administrative databases are increasingly used to measure drug exposure in perinatal pharmacoepidemiology. We aimed to estimate the concordance between records of prescriptions filled in pharmacies and self-reported drug use during pregnancy. METHODS Data on self-reported medication use were collected at each trimester of pregnancy among a sub-sample from the Organization of Teratology Information Specialists Antidepressants in Pregnancy Cohort. Women were eligible if they were Quebec resident and provided their pharmacist's contact information. Maternal self-reports were compared with prescriptions filled in pharmacies, which are transferred to pharmaceutical services files of Quebec provincial health plan database (Régie de l'asssurance maladie du Québec). Positive and negative predictive values (PPV and NPV) for medications taken chronically (antidepressants, thyroid hormones), acutely (antibiotics), and as needed (antiemetics, asthma medications) were calculated. RESULTS Among the 93 participants (mean age = 30.2 ± 3.8 years), 41.9% (n = 39) took at least one antidepressant during pregnancy according to self-reports, and 39.8% (n = 37) according to pharmacy records. Other commonly used drugs were antiemetics (self-reported 22.6%, pharmacy record 24.7%), antibiotics (20.4%, 16.1%), asthma medications (15.1%, 15.1%), and thyroid hormones (10.8%, 8.6%). PPVs and NPVs were: (1) chronic medication: antidepressants PPV = 100% (95% confidence interval [CI], 100-100%), NPV = 96% (95% CI, 92-100%); thyroid hormones PPV = 100% (95% CI, 100-100%), NPV = 98% (95% CI, 95-100%); (2) Acute medication: antibiotics PPV = 87% (95% CI, 70-100%), NPV = 92% (95% CI, 86-98%); (3) as needed medications: antiemetics: PPV = 78% (95% CI, 62-95%), NPV = 96% (95% CI, 91-100%); asthma: PPV = 33% (95% CI, 3-64%), NPV = 99% (95% CI, 97-100%). CONCLUSION The high PPV and NPV validate the use of filled prescription data in large databases as a measure of medication exposure. Birth Defects Research 109:423-431, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Jin-Ping Zhao
- Research Center, CHU Sainte-Justine, Montreal, Canada
| | - Odile Sheehy
- Research Center, CHU Sainte-Justine, Montreal, Canada
| | - Jessica Gorgui
- Research Center, CHU Sainte-Justine, Montreal, Canada.,Faculty of Pharmacy, University of Montreal, Montreal, Canada
| | - Anick Bérard
- Research Center, CHU Sainte-Justine, Montreal, Canada.,Faculty of Pharmacy, University of Montreal, Montreal, Canada
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10
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Abstract
BACKGROUND The Medication Possession Ratio (MPR) is a ubiquitous and central measurement for adherence in the health care industry. However, attempts to standardize its calculation have failed, possibly due to the opacity of a single, static MPR, incapability of directly lending itself to a variety of studies, and challenges of comparing the value across studies. This work shows that the MPR strictly depends on the length of the time interval over which it is measured as well as on the dominant dispense quantity for short time intervals. Furthermore, removing a proportion of the patient cohort based on the number of acquisitions may also have a severe impact on the MPR. Therefore, it is suggested that the MPR is represented as a trend over a range of time intervals. To this end, an upper and lower bound of the MPR trend is developed with an upper bound acknowledging patients who change their treatment and the lower bound acknowledging patients who discontinue their treatment. PURPOSE Introducing a representation of the MPR value as a trend rather than a static number by developing a quantitative description of an upper and lower bound of the MPR trend, while shedding light on the impacts on prefiltering the patient cohort. PATIENTS AND METHODS Anonymized patient-level data was utilized as an example for a suggested calculation of an upper and lower bound of the MPR. RESULTS Representation of the MPR for a predefined time interval precludes a reliable MPR assessment. A quantitative approach is suggested to generate an upper and lower trend of the MPR while emphasizing the impact on removing patients with a limited number of acquisitions. CONCLUSION An upper and lower trend makes the MPR more transparent and allows a better comparison across different studies. Removing patients with a limited number of acquisitions should be avoided.
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Affiliation(s)
- Christian M Sperber
- Patient Connect Limited, Guildford, UK
- Correspondence: Christian M Sperber; Suren R Samarasinghe, Patient Connect Limited, One London Square, Guildford, GU1 1NU, UK, Tel +44 1483 419 381, Fax +44 1483 546 498, Email ;
| | - Suren R Samarasinghe
- Patient Connect Limited, Guildford, UK
- Correspondence: Christian M Sperber; Suren R Samarasinghe, Patient Connect Limited, One London Square, Guildford, GU1 1NU, UK, Tel +44 1483 419 381, Fax +44 1483 546 498, Email ;
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Lentine KL, Lam NN, Schnitzler MA, Garg AX, Xiao H, Leander SE, Brennan DC, Taler SJ, Axelrod D, Segev DL. Gender differences in use of prescription narcotic medications among living kidney donors. Clin Transplant 2015; 29:927-37. [PMID: 26227016 DOI: 10.1111/ctr.12599] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2015] [Indexed: 11/27/2022]
Abstract
Prescription narcotic use among living kidney donors is not well described. Using a unique database that integrates national registry identifiers for living kidney donors (1987-2007) in the United States with billing claims from a private health insurer (2000-2007), we identified pharmacy fills for prescription narcotic medications in periods 1-4 and >4 yr post-donation and estimated relative likelihoods of post-donation narcotic use by Cox regression. We also compared narcotic fill rates and medication possession ratios (MPRs, defined as (days of medication supplied)/(days observed)), between donors and age- and sex-matched non-donors. Overall, rates of narcotic medication fills were 32.3 and 32.4 per 100 person-years in periods 1-4 and >4 yr post-donation. After age and race adjustment, women were approximately twice as likely as men to fill a narcotic prescription in years 1-4 (adjusted hazard ratio, aHR, 2.28; 95% confidence interval, CI, 1.86-2.79) and >4 yr (aHR 1.70; 95% CI 1.50-1.93). MPRs in donors were low (<2.5% days exposed), and lower than among age- and sex-matched non-donors. Prescription narcotic medication use is more common among women than men in the intermediate term after live kidney donation. Overall, total narcotic exposure is low, and lower than among non-donors from the general population.
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Affiliation(s)
- Krista L Lentine
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA.,Division of Abdominal Transplantation, Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Ngan N Lam
- Division of Nephrology, University of Alberta, Edmonton, AB, Canada
| | - Mark A Schnitzler
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA.,Division of Abdominal Transplantation, Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Amit X Garg
- Division of Nephrology, Western University, London, ON, Canada
| | - Huiling Xiao
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA
| | | | - Daniel C Brennan
- Transplant Nephrology, Washington University School of Medicine, St. Louis, MO, USA
| | - Sandra J Taler
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - David Axelrod
- Division of Abdominal Transplantation, Department of Surgery, Dartmouth Hitchcock Medical Center, Hanover, NH, USA
| | - Dorry L Segev
- Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
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