Summary of findings 2.
Outcome: drug expenditures ‐ 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) | Long Term (>24 Months) |
| Absolute change in level | Relative change in level | Relative change in level | Relative change in level | Relative change in level | ||
| Bursey 2000 | PPI restriction Expenditures to treat upper gastrointestinal disorders in 6 mo intervals |
$153 | ‐19.6% | At 6 months ‐ 85% (‐92.6%, ‐77.9%) At 12‐months ‐ 84% (‐89.7%, ‐79.3%) |
At 24 mo ‐ 79% (‐82.8%, ‐75.2%) |
|
| Delate 2005 /ITS | PPIs Per member per month |
PPIs decreased 90.9% H2RAs Increased 223.2% |
PPI decreased from $44.1 million to $13.5 million H2A drug expenditures increased from $6.0 million to $13.5 million |
Absolute decrease from $3.44/PMPM to $1.74/PMPM Net expenditure decrease of $23.4 million |
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| Fischer 2007 /CITS | Angiotensin receptor blockers (ARBS) | For PDL: 0.4% p=0.049 For ACE trial: ‐1.0% p=0.003 |
ACE trial: ‐0.7 p<0.001 Slope Effect PDL: 0.3% p<0.001 |
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| Fischer 2004 /CITS | COX‐2 Inhibitors | ‐ $10.28 ($7.56, $13.00) p<0.001 | 18% | |||
| Grootendorst 2005 /ITS | NSAIDS, analgesic drugs | Cummulative effect per year: Type 1 RP: ‐$1,035,340 (95% CI ‐$1,505,318, ‐565,362 p<0.001) Type 2 RP: ‐$4,007,322 (‐$4,378,332, ‐$3,36, 312 p<0.001) |
Over all months: Type 1 RP: ‐$7,506,21 (95% CI ‐10,900,00, ‐$4,098,872) Type 2 RP (95% CI ‐$22,700,000 (95% CI ‐$24,800,000, ‐$20,600,000 p<0.001) |
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| Hartung 2004 /CITS | COX‐2 Inhibitors | Savings attributable to the PA policy were projected to be approximately $10,402 (linear model) and $4999 (logarithmic model) per month. | Mean projected savings attributed to the PA policy was $2.87/Person Year (PY) (linear) $1.40/PY (logarithmic) . | |||
| Hartung 2006/ ITS | PPIs, long acting opioids, NSAIDS, statins | Aggregate: DAW Exception: ‐$0.18 (‐$0.08, ‐$0.02 p<0.05) Soft PA: $0.28 ($0.11, $0.44 p<0.05) Voluntary ‐$0.10 (‐$0.26, $0.06) |
Aggregate: DAW Exception: ‐9.1% (95 % CI ‐13.8%, ‐4.3% p<0.05) Soft PA: ‐17.7% (95% CI ‐25.4%, ‐10.0% p<0.05) Voluntary 5.5% (95% CI‐‐1.1%, 12.1%) |
Estimated savings during entire period: DAW policy: $1,727,392 (95% CI $976,102, $2,478,682) Soft PA policy: $2,223,300 (95% CI $1,816,027, $2,854,353) |
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| Keith 1994 /ITS | H2RAs | Adjusted net savings of: $275,920. | ||||
| Law 2008/ CITS | 2nd generation antipsychotics | No significant change | Costs rose 7.95 to $9.84 over study period, Texas: $9.19 to $10.49 | |||
| MacCara 2001 /ITS | Fluoroquinolone | $605,890. (23.7%) decrease | ||||
| Marshall 2006 /ITS | Fluoroquinolones | Fluoroquinolones: $105,707 less per week, p<0.001) | ||||
| Motheral 2004 | NSAIDS, PPIs, SSRIs | In all 3 therapy classes, an immediate decrease of $0.93 PMPM costs p<0.01. Savings of 19% of net costs relative to mean monthly preperiod expenditures | In month following step therapy: NSAIDS: decrease of $0.29/PMPM p<0.001 SSRI: no significant change PPIs: decrease of $0.48 net drug cost p<0.05 |
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| Roughead 2006 /CITS | COX‐2 Inhibitors | Average cost per NSAID prescription: Unrestricted access: $59.00 Late policy adopting: $46.00 Early policy: $40.00 |
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| Schneeweiss 2004 / CITS | Nebulized respiratory drugs | ‐ $24 PMPM (‐$19, $29) | ||||
| Schneeweiss 2006 /ITS | PPIs | Reduction of $3.2 per senior Estimated savings of $2.9 million |
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| Smalley 1995 /CITS REPORTED |
Non‐generic NSAIDS per person per year |
‐ $14.63 | ‐ 65% (‐ 60%, ‐71%) | Slight upward trend of $0.17 per month ($0.02, $0.32) | ‐ 53% (‐48%, ‐57%) | |
| Smalley 1995 /CITS REANALYSIS |
‐$13.45** | ‐ 58.5%** | ‐57.2%** (‐59.7%, 54.7%) | ‐ 56.1%** (58.0%, ‐54.1%) | ||
| Relaxation or exemption from restriction | ||||||
| Fretheim 2007 /ITS | Antihypertensives | Savings of U.S. $0.72 million, or U.S. $0.16/inhabitant | ||||
| van Driel 2008 /ITS | H2As and PPIs | Public expenditure for acid suppressants increased from a total of € 7.5 million in 1997 to €12. million in 2005 | ||||
*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