Summary of findings for the main comparison.
Outcome: drug use ‐ CITS and ITS studies
|
Study ID* (CITS) |
Outcome / drug or drug class | Immediate after transition period (95% CI) | Immediate after transition period (95% CI) | Short Term (6 mo, 1 yr) (95% CI) | Long Term (12mo, 24 mo) (95% CI) |
| Absolute change in level | Relative change in level | Relative change in level | Relative change in level | ||
| Delate 2005 | Per patient per month PPI and H2RA drug claims | ‐0.02 PPI 0.01 H2RA |
‐ 92% PPI 98% H2RA |
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| Fischer 2007 /CITS | Proportion of renin‐ angiotensln ‐aldosterone system (RAAS)‐blocking defined daily doses (DDDs) accounted for by ARBs | Any PA policy ‐ 0.4% (NS) Slope effect 0.0% (NS) States requiring ace inhibitor trial first ‐1.6% (p=0.026) * one time decrease |
States requiring ace inhibitor trial first ‐1.3 % per quarter to 18 months (p<0.001) |
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| Fischer 2004 /CITS | Proportion of nonsteroidal anti inflammatory drugs (NSAID) DDDs accounted for by COX‐2 Inhibitors | ‐ 11.1% ( ‐5.7%, ‐16.5%) 6 mo post relative to 6 mo pre | ‐1.6% (0.0%,3.1%) per quarter to 18 months (p=0.03) | ||
| Hartung 2004 /CITS | Days' supply per person‐year celecoxib | ‐ 0.54 (from 1.07 to 0.53) | ‐ 58.9% (‐50.0%, ‐67.9%) | decrease slope (P < 0.001). |
|
| Hartung 2006 | Market share in aggregate of prefered drugs in the PPIs, NSAIDS, long‐acting opioids and statin drug classes | "Dispense as Written" period 8‐9 months +28 "Soft PA period " ‐ education 5 months +42.9 Voluntary 9 months ‐17.4 |
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| Keith 1994 | Mean number of dosage units H2RAs dispensed per month | 11 months ‐ 35% (from 69,212 to 44,751 units /mo) 0.7% slope |
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| Percentage of patients taking other drugs known to produce significant drug interactions | ‐ 7.5 % (from 14 to 6.5%) | ||||
| Kephart 2005 /CITS | Monthly use of wet nebulization therapy | decrease p<0.001 | slower decline p<0.001 | 24 months Dec 99 to 01 Decline from 100% to 36% in heavy users Decline from 67% to 20% in all users |
|
| Law 2008 /CITS | Market share level of nonpreferred 2nd generation antipsychotics | West Virginia: ‐ 3.5% (‐5.7%, ‐1.3% p=0.003) Texas: ‐2.6% (0% , ‐5.2% p=0.55) |
West Virginia: ‐1.3% (–1.8%, –.8%, p<.001) per quarter Texas: decrease in trend NS |
24 months ‐13.8% (‐9.4%, ‐18.2% p<0.001) |
|
| MacCara 2001 | Fluoroquinolone claims | ‐ 80.2% | |||
| Marshall 2002 | Mean no. defined daily doses (DDD) of all PPIs per 100,000 seniors per month | ‐22,959 (from 84,531 to 62,708) | ‐15.6% (during 6 mo transition following announcement) | ‐26% first year | 13 to 41 months 9% over baseline |
| Marshall 2006 | Fluoroquinolone prescriptions per week | To 15 months post policy absolute decrease of 1905 (p<0.0001) | |||
| Schneeweiss 2004 | Use of respiratory drugs during two months follow up | At 6 months nebulised drugs ‐ 7% p < 0.001 nebulised in combination with inhaled drugs ‐ 25% (p < 0.001) |
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| Schneeweiss 2006 | Monthly dispensed daily doses per 10,000 residents restricted and reimbursed PPIs | 8 months post implementation Total PPI utilization No level change (p=0.82) ‐ 383 slope (p‐0.08) Restricted PPI ‐ 14,850 ( ±1100) Reimbursed PPI rabeprazole 19,300 ( ± 2200) (p < .0001) with 45% switching rate |
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| Smalley 1995 /CITS REPORTED |
‐ 26% (‐21, ‐31%) | 2 year period compared with baseline ‐19% (‐13, ‐25) |
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| Smalley 1995 /CITS REANALYSIS** |
Days of NSAID use per Person‐Year | ‐4.35 | ‐ 23% | 6 months ‐ 21% (‐23%, ‐19%)** |
At 23 months ‐ 21% (‐22, 19%)** |
| Soumerai 2008 /CITS |
Atypical antipsychotic use | 10 month No significant difference |
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| Relaxation of restrictions to reimbursement | |||||
| Bjerrum 2001 | Incidence prevalence rates of lipid lowering drug per 100,000 per month | 14 | 1st year 0.4% increase prevalence |
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| Fretheim 2007 | Proportion of thiazide prescriptions among all prescriptions for patients started on treatment for uncomplicated hypertension | 16.5% (9.9%, 24.8%) ‐ 0.05% slope change (NS) per month (0.65% to 0.35%). |
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| Jackevicious 2008 | Monthly rate of clopidogrel use within 30 days of hospital discharge following MI recieving stents | 53% | |||
| Sakshaug 2007 | 1 yr prevalence of statin use | At 1 yr 6.8% increase women 8.1% increase men |
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| van Driel 2008 | Monthly reimbursed DDD for total H2As and PPIs | from 1997 to 2005 222% |
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* Analyses from included studies that provided comparable data on immediate, short term and long term impact are provided in this table. Some analyses, such as studies combining and comparing data over many jurisdictions, are reported narratively to aid appropriate interpretation; ** Reanalyses conducted by reviewers based on time series data provided by original study