Study Design

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Unformatted text preview: The information contained in this presentation is intended for dissemination to business partners of MedImpact Healthcare Systems, Inc., only. Any other unauthorized use is strictly prohibited. Date: Value-Based Benefit Design: A Propensity Score Weighting Method February 17, 2011 Feng Zeng, PhD, MedImpact Bimal Patel, PharmD, MS, MedImpact Costs versus Quality For years, payers have been under pressure from two fronts: Need to increase cost sharing to contain the escalating costs Need to invest more money to improve quality of care Value Based Benefit Design (VBBD) argues that cost containment and quality of care are two sides of the same coin. Value-Based Benefit Design? VBBD varies copay based on clinical benefits instead of costs. Lower copay for high-value therapy Increase copay for marginal-value therapy VBBD acknowledges: Different clinical benefits across the population Patients limited ability to differentiate high-value therapy and low-value therapy Initially advocated by Fendrick et al, 2001 in AJMC Fendrick et al, 2001, A Benefit-based copay for prescription drugs: patient contribution based on total benefits, not drug acquisition cost. AJMC , 7:9. University of Michigan Center For Value-Based Insurance Design http://www.sph.umich.edu/vbidcenter/ Proposed VBBD Trade-Off for Payers Increase Pharmacy Costs Through Lowered Patient Copayment Increased medication compliance resulting in: Improved Outcomes, Reduced Hospitalizations, Reduced ER visits, Improved quality of care Reduced disability How effective is VBBD? Pitney Bowes (PB) Experience Background Fortune 500 Company with 23,000 employees VBBD Design Tier Structure before VBBD Tier 1: 10%; Tier 2: 30%, Tier 3: 50% VBBD Drugs: Asthma, diabetes and hypertension drugs VBBD Copayment: all VBBD drugs with 10% copayment Results for diabetes patients 2 years after VBBD : Number of non-adherent patients decreased by 2/3 Total pharmacy costs for diabetes patients decreased by 7% Average cost of care for diabetes patients decreased by 7% Published in AJMC in 2005 Copay Reduction within a Disease Management Environment Background A large employer within a telephonic DM environment VBBD Design For 5 drugs: ACE inhibitors & ARBs, beta-blockers, Diabetes, statin and steroid Generics: $5 $0 Preferred brand: $25 $12.5 Non preferred brand: $45z $22.5 Overall copay reduced by about 29.9% Control group: Another employer in the same DM Findings: Compliance increased 4.02 for diabetes drugs, 3.39 for statins, 2.59 for ACE/ARBs, 3.02 for beta-blockers Skepticism to VBBD Methodological concerns for two VBBD studies: No control group for the Pitney Bowes paper Little information whether the case and the control groups were comparable for the Health Affairs paper The effects and costs of VBBD have not been thoroughly understood Scant evidence on the effectiveness of VBBD...
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This note was uploaded on 09/14/2011 for the course PHARM sd taught by Professor Staff during the Spring '11 term at UCSD.

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Study Design - The information contained in this...

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