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Sullivan, Sean D. 1960-

Works: 16 works in 30 publications in 2 languages and 416 library holdings
Genres: Academic theses 
Roles: Thesis advisor, Editor, Other
Publication Timeline
Publications about Sean D Sullivan
Publications by Sean D Sullivan
Most widely held works by Sean D Sullivan
Asthma's impact on society : the social and economic burden by Kevin B Weiss( Book )
12 editions published between 1999 and 2000 in English and held by 176 libraries worldwide
"One of the first comprehensive studies of the social and economic consequences of this chronic pulmonary illness, Asthma's Impact on Society assesses how communities, families, and individuals confront asthma and try to minimize its deleterious effects."--Jacket
Measurement and evaluation of outcomes in COPD ( Book )
2 editions published in 2003 in English and held by 7 libraries worldwide
The impact of adherence and an intervention program on patient outcomes and costs in chronic hepatitis C infection by Cara Lyn McDermott( file )
1 edition published in 2012 in English and held by 3 libraries worldwide
Background and aims: Both observational studies and randomized trials have shown that higher medication adherence is associated with improved outcomes in patients with chronic hepatitis C infection (CHC). Little evidence exists on the association between adherence and health care costs. We sought to evaluate the impact of adherence on long-term outcomes and costs in a population of patients with CHC genotype 1 receiving peginterferon and ribavirin (PEG-RBV). We also evaluated the impact of a potential intervention to improve adherence on long-term costs and patient outcomes. Methods: We utilized a cohort Markov model describing the natural history of hepatitis C infection in a population of 50 year-old treatment-experienced adults to evaluate the following health states: CHC, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, liver transplant, liver transplant survivor, and death. Using previously published data from the HALT-C trial, we modeled four levels of medication receipt:>80% PEG-RBV,>80% PEG/<80% RBV, <80% PEG/<80% RBV, and <80% PEG-RBV. The costs and quality-adjusted life years (QALYs) associated with moving patients to higher level of adherence was compared to the cost associated with a nursing-based intervention program. Time horizons of 5, 10, 20, 30 years and lifetime were evaluated. Results: Over a lifetime horizon, we compared patients with the highest adherence versus lowest adherence, and found the following reductions in liver-related events: 9.9% compensated cirrhosis, 4.7% decompensated cirrhosis, 1.4% hepatocellular carcinoma, and 0.5% liver transplant. The potential cost savings over a lifetime as patients move from a cohort of lower SVR to greater SVR ranged from $12,820-$62,690, with a 1% increase in SVR associated with savings of $2137-$3284. Conclusion: Interventions that increase patient adherence should improve outcomes in this population and have the potential to reduce costs
Migraine-specific health resource utilization in chronic and episodic migraine across six countries by Joanna C Sanderson( file )
1 edition published in 2012 in English and held by 3 libraries worldwide
Background: Though studies have consistently revealed variation in resource utilization between chronic and episodic migraineurs, less is known about how these differences compare across countries. This research describes migraine-specific health resource utilization in chronic and episodic migraineurs across the United States (US), Canada, the United Kingdom (UK), Germany, France and Australia. Methods: A web-based screening survey, used to determine eligibility, was administered to 32,782 panelists who had previously reported experiencing headaches or migraines. Screener respondents (n=16,663) were eligible for the main questionnaire if they were ≥ 18 years of age, reported at least one headache (not associated with a cold, flu, head injury, or hangover) during the prior three months, and reported symptoms meeting the revised second International Classification of Headache Disorders (ICHD-IIR) diagnostic criteria for migraine. For the main questionnaire, respondents provided data concerning sociodemographic and clinical characteristics, attitudes, and utilization of health resources. Results: In bivariate analyses, the intensity of resource use differed across countries in each migraine type. In multivariate regression, the odds of visiting a provider for headache in the three months prior to completing the survey were higher in all countries relative to the US. The odds of having a typical provider of headache care were also higher in all countries relative to the US, but this was only significant for France (OR 1.85, 95% CI 1.04, 3.32). Relative to the US, the odds of having ever visited the emergency room for headache were significantly lower in France (OR 0.37, 95% CI 0.22, 0.62), the UK (OR 0.25, 95% CI 0.14, 0.45) and Germany (OR 0.31, 95% CI 0.18, 0.53). Respondents from Australia (OR 1.83, 95% CI 1.13, 2.96) and France (OR 1.51, 95% CI 1.00, 2.28) were more likely than those from the US to report ever trying more than three abortive agents. The odds of currently using a prescription abortive agent were significantly higher in France (OR 1.80, 95% CI 1.19, 2.74), the UK (OR 2.68, 95% CI 1.72, 4.17), Australia (OR 1.88, 95% CI 1.16, 3.03) and Germany (OR 2.10, 95% CI 1.37, 3.23) than in the US. Conclusion: Migraineurs differed significantly across countries in their demographic and clinical characteristics, and in the resources they utilized. Migraineurs from the US were generally less likely to report use of preventative services, such as recent provider visits and use of prescription abortive agents, and more likely to report emergency room visits, relative to migraineurs from the other countries studied. However, US migraineurs were also less likely to report ever being hospitalized for headache compared to migraineurs from Canada and Australia. Further research on the sources of this variability, including the influence of healthcare system design features, and the effects of the variability on outcomes in migraineurs is warranted
Investigating the association between sedative hypnotic prescription exposures and motor vehicle crashes by Ryan Nicholas Hansen( file )
1 edition published in 2012 in English and held by 3 libraries worldwide
Background Motor vehicle crashes occur daily and may be fatal for the driver, passengers or bystanders. Crashes have been shown to be associated with certain medical conditions and exposure to prescription medications that impair the ability to drive. We sought to create a linked, population-based longitudinal crash and medical care use dataset and to evaluate the relationships between prescription opioid and sedative hypnotic medication exposures and automobile crashes in Washington State. Methods Crash data from the Washington State Department of Transportation from 2002 to 2009 were linked to medical, pharmacy and administrative data from the Group Health Cooperative (GHC) for all eligible members. Continuous prescription exposures were defined based on fill records for opioids and sedatives. We estimated multivariate extended Cox regressions to investigate the association between police-reported crashes and prescription fills for opioids and sedative hypnotics. We also stratified our analyses by the length of continuous prescription fills. Results A total of 676,694 subjects were included in the study. These individuals experienced 2.41 motor vehicle crashes per 100 person-years. Opioid prescription fills were associated with a hazard ratio of 1.37 (95% CI: 1.33 to 1.41). Stratifying opioid exposure by the length of continuous prescriptions resulted in a range of hazard ratios from 1.76 at 30 days (95% CI: 1.59 to 1.96) up to 11.33 at 120 days (95% CI: 9.18 to 13.98). Overall incident sedative prescriptions were associated with a hazard ratio of 2.23 (95% CI: 1.92 to 2.59). Stratifying continuous prescriptions by length revealed the highest risk group to be 121-240 days for all sedatives, trazodone and temazepam (overall HR: 6.84, 95% CI: 4.15 to 11.2). Zolpidem had no risk of crash in the first 30 days, yet risk climbed to a peak risk between 241-360 days (HR: 10.7, 95% CI: 3.9 to 29). Discussion The risk of motor vehicle crash is increased in people who fill prescriptions for opioids and sedative hypnotics. The hazard ratios estimated are equivalent to blood alcohol concentrations in excess of double the legal limit to drive. Public health may be improved by reducing driving time when using these medications
Antiepileptic drug switching and epilepsy-related events in subjects with epilepsy : a case-control analysis of health insurance claims data by Hiep Nguyen( file )
1 edition published in 2013 in English and held by 1 library worldwide
Epilepsy is frequently debilitating and switching between bioequivalent antiepileptic drugs (AEDs) with narrow therapeutic index remains controversial. Methods: We investigated the association between A-rated switching and emergent treatment for an epilepsy-related event over a 1-year period using recent claims data from the Truven Health MarketScan® Commercial Database. Cases and matched controls with a diagnosis of epilepsy were identified using emergency services and inpatient visits or outpatient visit claims, respectively. Cases and controls were matched using a 1:1 ratio for age within 5 years of the case's age and seizure diagnosis category. The exposure was defined as an A-rated switch of an AED during the 90 days prior to index date. Adjusted analyses controlled for matching, sex, AED type (older vs. newer AEDs), Deyo-Charlson comorbidity index score, and total number of AED prescription filled. Results: 1,873 of 7,843 (24%) cases and 1,566 matched controls (20%) experienced an A-rated switch. The unadjusted odds of an epilepsy-related event were 1.26 for switchers (95% CI: 1.17-1.36), and after controlling for all confounders, 1.15 (95% CI: 1.06-1.25). Compared with other AEDs, switching of carbamazepine and phenytoin is associated with increased risk of epilepsy-related events. Individuals with epilepsy who switch between A-rated formulations of AEDs are more likely to experience an emergently treated epilepsy-related event compared with individuals who do not switch. Compared with newer AEDs, switching of some older AEDs such as carbamazepine and phenytoin is associated with increased risk of epilepsy-related events. Effective management of epilepsy requires clinicians, pharmacists, and patients to understand the factors associated with bioequivalent medication substitutions. Physicians and pharmacists should actively seek to prevent switching of anti-epileptic medications once patients are stabilized on a specific product - whether branded or generic version. Such switching increases the odds of an epileptic event
Trends in cost, health status and functional outcomes among adult and pediatric patients with asthma : 2000-2009 by Junho Jang( file )
1 edition published in 2012 in English and held by 1 library worldwide
Background: Asthma, a chronic inflammatory disease of the respiratory tract, has a high prevalence and substantial deleterious effects on health care costs in the U.S. Very few studies have examined recent trends in medical expenditures, health status, and functional outcomes among patients with asthma. Objectives: To examine the level and changes in medical costs, health status and functional outcomes in adults and pediatrics with asthma and to provide nationally representative estimates of medical costs from 2000 through 2009. Methods: Data from the 2000-2009 Medical Expenditure Panel Survey (MEPS) were used. Patients with asthma were identified by self-reported lifetime asthma diagnosis or medical condition based on International Classification of Disease, Ninth Revision, Clinical Modification. We studied the trends among three age groups: adults age 18 and above, adolescents ages 6-17, and children ages 0-5. Generalized linear models were used to examine the change in health care costs (adjusted for medical price inflation) and functional outcomes (number of work days lost (WDL) in adults and number of school days lost (SDL) in adolescents), while ordinary least square regression (OLS) was used for health status outcome (Physical Component Summary (PCS) and Mental Component Summary (MCS) from SF-12v2 Health Survey), adjusting for clinical and demographic characteristics, socioeconomic status and comorbidity. Two part models were used to estimate the medical costs of asthma. Results: Among adults, the mean PCS decreased 0.09 units annually (p<.01) and the trends of mean MCS was not significant. There was no significant change in the number of WDLs and marginal decrease in SDLs with 1.8% annually (p=.06). The trends of medical costs in adults and children with asthma were not significant. However the medical expenditures increased 2.5% annually during the ten year period in adolescents (p=.049). For the most recent year available (2009), the total incremental health care costs of asthma in the United States were $53 billion, $7 billion and $3 billion in adults, adolescents and children, respectively. Conclusion: This study finds that over a 10-year period, medical costs in asthma patients have increased or remained similar in all age groups, while outcomes have not improved. These data reflect a period of time in the US where increasing attention has been paid to asthma disease management. The lack of improvement in outcomes suggests that approaches to asthma management in the U.S. should be reexamined and modified
The economic burden of diabetic macular edemia in a working age and commercially insured population by Christopher John Wallick( file )
1 edition published in 2013 in English and held by 1 library worldwide
Diabetic Macular Edema (DME) is the leading cause of blindness amongst working age adults in most developed countries. Diagnosis and treatment of DME involves many visits to specialists, numerous medications, and great cost. The primary objective of this study was to describe the economic burden of DME in a commercially insured working age population. We conducted a retrospective cohort study using enrollment and health care claims information from a large database of commercially insured, working age adults. We matched a cohort of patients with a claim for DME 1:5 to a diabetic control group without DME and reported health care utilization and cost over a 1, 2 and 3 year period. The DME cohort had significantly more comorbidities and a higher Charlson Comorbidity Index (CCI) scores than the matched diabetic control cohort. Health care resource utilization rates were significantly higher in DME patients than diabetic control patients for every category. DME patients had claims for significantly higher counts of emergency, outpatient, and inpatient visits than the diabetic control cohort. The total number of days with a visit to any healthcare provider was on average more than 10 days greater in DME cohort patients than in non-DME diabetic patients (27.01 vs. 16.13 days). Among the DME cohort this represents, on average, a visit to a healthcare provider more than once every 2 weeks over the course of a year. We characterized utilization patterns for DME patients and compared them to matched non-DME diabetic patients. We found that DME patients utilized significantly more health care resources and accrued higher costs than the non-DME diabetic patients. DME patients also made more visits to health care professionals. The burden of disease for DME patients is large and may represent a challenge for patients that are trying to attend to family or work. The large and rising cost of treatment only adds burden to patients that are likely already missing work time to visit specialists. DME patients that have nearly 30 days per year with at least one provider visit are likely to have difficult decisions between seeking treatment and taking care of their family or going to work
The impact of depression on patient outcomes among older adults with lung cancer by Cara Lyn McDermott( file )
1 edition published in 2016 in English and held by 1 library worldwide
Background: Depression is a common malady among older adults, and as the incidence of cancer increases with age, older adults may be living with both cancer and depression. Previous studies have assessed the impact of depression on patient outcomes when depression is measured around the time of a cancer diagnosis or during cancer treatment, but we know very little about how depression preceding the cancer diagnosis affects patient outcomes during the course of cancer treatment. Using the example of lung cancer, the most common cause of cancer death among older adults, we examined the association between pre-existing depression and cancer stage at diagnosis, survival, and health care utilization. Methods: We used the national Surveillance, Epidemiology, and End Results (SEER) database, linked to Medicare healthcare and prescription claims, to examine the association between pre-existing depression and patient outcomes for older adults with non-small cell lung cancer (NSCLC) diagnosed between 2008-2011 with claims from 2007-2013. We used multivariate logistic regression models to investigate the association of pre-existing depression, advanced NSCLC stage at diagnosis, and receipt of aggressive end-of-life care. We estimated multivariate Cox proportional hazards models to examine the association of pre-existing depression and overall survival. We utilized competing risk regression models to examine the relationship between pre-existing depression and time to anticancer therapy or hospice enrollment. Results: We included 24,666 people in our analysis. Older adults with pre-existing depression were less likely to be diagnosed with advanced stage NSCLC (OR 0.76, 95% CI 0.68-0.85). Of the 8,873 older adults with stages 1-3A NSCLC, persons with pre-existing depression and stage 1 NSCLC had a higher risk of death compared to those without depression (OR 1.19, 95% CI 1.01-1.41). We found similar patterns of anticancer therapy receipt between older adults with or without pre-existing depression, and no significant difference in time to first anticancer treatment, accounting for the competing risk of death. Among 14,385 decedents with stage 3B or 4 NSCLC, those with pre-existing depression were more likely to enroll in hospice than persons without depression (SHR 1.16, 95% CI 1.06-1.28). We found no difference in utilization of inpatient hospitalizations, emergency room use, or chemotherapy receipt in the last 30 days of life, comparing those with versus those without pre-existing depression. Discussion: In a national sample of older adults with NSCLC, pre-existing depression was associated with earlier stage at cancer diagnosis, shorter survival among those with early stage NSCLC and higher hospice utilization among persons with advanced NSCLC. These findings indicate the importance of screening for and treating depression during cancer therapy. As people with pre-existing depression are more likely to enroll in hospice, it is important that hospice organizations and caregivers have sufficient support to address cancer and mental health concerns at end-of-life
Bariatric surgery for severe obesity : determinants of use and economic impact by Rafael Alfonso-Cristancho( file )
1 edition published in 2013 in English and held by 1 library worldwide
Obesity in the U.S. population is a major public health problem with important clinical and economic implications. Bariatric surgery is currently the most effective long-term weight loss treatment for morbid obesity but less than 2% of the potentially eligible population has undergone the procedure. Our aims were to: 1) determine the patient characteristics associated with receiving a bariatric procedure among eligible patients; 2) identify patient characteristics that could be used as predictors of resource use and costs in severely obese patients with and without bariatric surgery; and 3) estimate and project the differences in long-term costs and outcomes across different clinically defined populations undergoing bariatric surgery compared to non-surgical approaches, refining a previously developed cost-effectiveness model. Methods: We used electronic medical records from members of Group Health Cooperative, based in Washington State to identify severely obese individuals, eligible for bariatric surgery, from 2004 to 2010. The probability of undergoing bariatric surgery was assessed using multivariate logistic regression adjusting for demographic and clinical characteristics, as well as patterns of practice. To determine the predictors of costs, we used generalized linear models for both groups with similar adjustment variables. We created a propensity score matched cohort based on specific characteristics previously identified at the date of surgery and the assigned index date for those who did not have surgery. Finally, we used these data to update a previously developed cost-effectiveness model to re-estimate the cost-effectiveness of bariatric surgery compared to non-surgical interventions. A total of 48,166 subjects were identified as eligible for bariatric surgery. Only 1,129 had bariatric surgery. The characteristics associated with having a bariatric procedure were: having insurance coverage for the procedure (OR=5.61; 4.71-6.68), higher body mass index (BMI) (1.10; 1.09-1.11), and older age (1.00; 1.00-1.01). The presence of comorbidities was associated with higher odds of having surgery. Examining comorbidities individually, only coronary heart disease was not associated with the surgery (0.96; 0.74-1.26). These characteristics changed over time, showing time trends towards increasing numbers of older adults and subjects with lower BMI having the procedure in the recent years. For costs, total annual costs were higher prior to surgery in the bariatric surgery group but decreased more (in absolute and relative terms) after the surgery compared to the non-surgical group. The total health care costs post-surgery for both groups were primarily driven by inpatient costs. The presence of comorbid conditions was associated with greater annual total costs in both groups. Major cardiovascular risk factors, such as coronary heart disease, hypertension, diabetes, and a higher comorbidity index, were associated with the highest increase in mean annual total costs. Despite being more expensive, bariatric surgery is cost-effective due to the impact on weight loss, which is associated with improved life expectancy and quality of life after the procedure. The incremental cost-effectiveness ratio of the bariatric surgery is sensitive to the presence of multiple comorbidities, mainly due to the reduction in the differences in the lifetime costs between surgical and non-surgical interventions for patients with multiple comorbidities. There are demographic, clinical, and insurance differences among subjects eligible for bariatric surgery that receive and do not receive the surgery. The presence of specific comorbid conditions increases the probability of surgery and is associated with higher total costs in this population. The cost-effectiveness of these procedures also depends on the presence of specific comorbid conditions. Understanding these differences could better inform the decisions that patients, clinicians, payers and policy-makers face in addressing the problem of increasing population obesity
Price elasticities of pharmaceuticals in a value-based-formulary setting by Kai Yeung( Book )
3 editions published in 2016 in English and held by 1 library worldwide
Ever since the seminal RAND Health insurance experiment (HIE) was conducted, most health care services, including pharmaceuticals, are deemed to be price inelastic with price elasticities of demand (PED) close to -0.20. However, most studies of PED exploit natural experiments that change demand prices for multiple components of health care. Consequently, these experiments usually do not produce estimates for the true own-price elasticities of demand but rather composite own-price elasticities that are driven by concomitant price changes to their substitutes and complements. Hence, an estimate of price elasticity is expected to vary based on the setting in which it was estimated, and likely not be applicable to other settings. In this work, exploiting a natural experiment of exogenous policy implementation of a value-based formulary (VBF) that was designed based on drug-specific incremental cost-effectiveness ratios, we estimate price elasticities of pharmaceuticals within a VBF design, formally accounting for the nature of composite elasticities that such a setting would generate. We also calculate welfare effects of such a policy using a consumer surplus approach. We show theoretically that VBF designs can increase dispersion of price elasticities of demand among pharmaceutical products compared to their true own-price elasticities and affect their magnitude based on direction of price change. Aligning these PEDs with value VBF is also likely to produce positive welfare effects. We estimate an overall PED for pharmaceuticals to be -0.16, close to the estimate of RAND HIE. However, we see substantial dispersion of PED across the VBF tiers ranging from -0.09 to -0.87 with trends aligned with the levels of value as reflected by the cost-effectiveness ratio (p<0.001). The net welfare increase was $147,000 for the cohort or $28 per member over the post-policy year. Further experimentations of VBF designs with alternative cost-effectiveness thresholds, copay
Implications and investigations of pharmacy benefit in the United States by Jonathan H Watanabe( file )
1 edition published in 2012 in English and held by 1 library worldwide
Medicaid clients are among the most at-risk members for poor health outcomes in society and this safety net health care is critical for assuring continuous access to medical care. We will describe the importance of curtailing unnecessary drug spend as well as generic utilization mechanisms already applied by payers. We will describe the background, implementation, and early findings of a prescriber feedback report card program to improve generic utilization in the Washington State Medicaid system. We quantified the association between possession of prescription drug coverage and likelihood of experiencing an emergency room [ER] visit and hospitalization in the adult United States population with private health insurance. For the outcomes of ER visits and hospitalizations, the ORs were 1.05 (95% confidence interval [CI], 0.95 to 1.15) and 1.07 (95% CI, 0.95-1.22) respectively using propensity score matching. Indicating a non-significant increase in odds of the outcomes of ER visit and hospitalization for patients possessing drug coverage . Multiple logistic regression produced similar findings. For the outcomes of ER visit and hospitalization, the adjusted ORs were 1.03 (0.96-1.12) and 1.01 (0.91-1.21) respectively. Prescription drug coverage in the United States was not associated with a reduction in likelihood of ER visit or hospitalization in this assessment pooling ten years of cross-sectional data. To estimate the reduction in adherence and medication supplied for patients that experience increases in average monthly copay over time for three therapeutically distinct drugs for chronic syndrome management using a nationally representative Commercial Claims databaseIncrease in $5 or more or $10 or more for average monthly copay was associated with a statistically significant reduction in MPR for all three drugs. Measured by generalized estimating equations, change in MPR varied from a minimum loss of 0.024 for simvastatin with a $5 or more increase in copay to a maximum loss of 0.063 for insulin glargine with $10 or more increase. This equates to a minimum loss of days supply 8.8 to 23.0 for simvastatin and insulin glargine respectively. Copay increases are associated with significant reductions in adherence of chronic medications necessary for optimal disease control
Does cost-effectiveness analysis have a role in US managed care drug formularies? : an empirical study of utilization, costs, outcomes, and elasticity of demand of a value-based formulary by Kai Yeung( file )
1 edition published in 2015 in English and held by 1 library worldwide
The standard economic model for health insurance posits that in order to account for moral hazard in a population for which there is varying marginal benefit of treatment that is unknown to the insurer, cost-sharing should be proportional to the price elasticity of demand. Yet, many have observed that when faced with cost-sharing, consumers may reduce utilization to suboptimal levels due to underestimation of the marginal benefit of treatment. Hence, optimal health insurance design requires consideration of both insurer and consumer information asymmetries regarding the marginal benefits of treatment. This dissertation investigates whether cost-effectiveness analysis (CEA) may be useful for optimizing insurance in the face of insurer and consumer information asymmetries. In 2010, Premera Blue Cross, a large non-profit health plan in the Pacific Northwest implemented a value based formulary (VBF) benefit among their own employees and dependents that explicitly uses CEA to inform medication placement within copayment tiers. We exploit this natural experiment to empirically assess the impact of the VBF on medication utilization and other health services utilization and the impact of the VBF on medication costs and non-medication costs from the member, health plan, and overall perspectives. We also estimate price elasticities of demand for pharmaceuticals overall, by therapeutic class, by brand-generic status, and finally by the copayment tiers informed by CEA. In the first paper, we use individual-level data from July 2006 to June 2013 drawn from the employees of Premera and their dependents as well as data from employees and dependents of 5 employer sponsored plans administrated by Premera and chosen based on similarity to the intervention group in industry classification. After controlling for member demographics and plan characteristics and secular trends using an interrupted time series design with concurrent control, we find that the VBF shifted member medication utilization towards drugs placed in lower copayment tiers. The VBF also was associated with increased member medication costs and decreased health plan medication costs, leading to a net medication savings of $8 per member per month (PMPM) (95% confidence interval [CI], -$15, -$2). Over the 3 year period of the study, the medication cost savings totaled over $1.1 million USD. The findings regarding non-medication costs were comparatively small and not statistically significant. Total costs decreased by $9 PMPM (95% CI, -$49, $30) but was not statistically significant. We did not detect any changes in the probability or the number of emergency department visits, hospitalizations, or office visits. This evaluation suggests that the VBF may have reduced overall medication costs without negatively impacting utilization of other health services – a proxy for adverse outcomes. In the second paper, we use data from July 2009 to June 2011 drawn from the employees of Premera and their dependents to construct a medication level dataset of 284 unique medications. These medications accounted for 79.3% of the prescription medication volume over the period of observation. After controlling for member demographics and using a pre-post design, we find that our elasticity estimates of -0.14 for the probability of filling a medication were similar to the overall elasticity estimates of -0.17 from the RAND Health Insurance Experiment. We also find that the estimates by therapeutic class and brand-generic status also were generally similar to published studies. Finally, we estimate of price elasticity of demand by copayment tiers informed by CEA. We found that elasticity estimates for the probability of fill and days’ supply of medication respectively were -0.07 and -0.06 for the preventive tier, -0.09 and 0.08 for tier 1, -0.26 and -0.26 for tier 2, -0.27 and -0.32 for tier 3, and -0.45 and -0.55 for tier 4. Thus we observed a general trend of increasing elasticity with increasing copayment tiers. These results suggest that a cost sharing strategy based on elasticity estimates may be similar to a cost sharing strategy informed by CEA. Furthermore, since in the first paper we observed that the VBF was associated with decreased medication costs without negatively impacting health services utilization, we suggest that the use of CEA to inform medication copayment tiers may have a role in optimizing insurance benefit design. Contemporaneous with the implementation of the VBF on July 2010, the US health insurance market has experienced many changes. The passage of the Patient Protection and Affordable Care Act (PPACA) in March 2010 and the progressive implementation of many provisions in that law have fundamentally altered the insurance and provider markets. One provision in PPACA explicitly supports the development of value-based insurance design. This provision has led to the promulgation of federal regulations that have focused on eliminating cost-sharing for certain preventive services. The PPACA also has mandated coverage of preventive services recommended by Advisory Committee on Immunization Practices and the US Preventive Services Task Force. Due to the direct influence these national advisory bodies now have on the coverage of preventive services, others have advocated use of CEA by these bodies to inform the relative costs and benefits of their decisions. Our research suggests that the application of CEA to explicitly inform cost-sharing may allow the expansion of value-based principles beyond waivers of cost-sharing for specific “high value” services. Another important provision of PPACA is the formation of Accountable Care Organizations (ACOs) by health care providers that are accountable for the quality, cost, and overall care of Medicare beneficiaries. Under this provision, the ACOs enter into payment contracts that share both financial risk and savings for the care of beneficiaries. This shift in financial risk may cause ACOs to become more aware of the cost of health care. Further, since providers can greatly influence medications utilization behavior, ACOs may become an important lever for the introduction of value-based principles in integrated delivery system models. Finally, PPACA and the Health Information Technology for Economic and Clinical Health Act of 2009 have financially incentivized the use of electronic health records (EHR). It is possible that future iterations of VBFs could utilize patient-level information from EHRs to more accurately triangulate levels of cost-sharing with better estimates of treatment benefit. Further, the adoption of electronic health records may allow for future evaluations of VBFs that are able to assess true health outcomes. In sum, changes in the health insurance market present many opportunities and challenges for the adoption and evaluation of value-based principles in health insurance design. Policymakers and researchers should carefully assess such dynamics when considering the role of value-based insurance in health insurance markets in the future. Footnote: A joint regulation issued by the Department of Health and Human Services, the Internal Revenue Service and the Department of Labor, regarding the elimination copayments for certain preventive services states “The Departments recognize the important role that value-based insurance design can play in promoting the use of appropriate preventive services.”
Data Investigation of Bariatric Surgery Outcome and Economic Savings ( file )
1 edition published in 2010 in English and held by 0 libraries worldwide
This study sought to (1) define the clinical impact and economic burden of bariatric surgical procedures, and (2) estimate the cost-effectiveness and budgetary impact of obesity treatments when compared to no surgical intervention. We developed a cost-effectiveness model and a payer-based budget and fiscal impact tool to compare bariatric surgical procedures to non-operative approaches for maorbid obesity. Use of these economic models based on data from the Department of Defense (DOD) population found that all evaluated surgical interventions were cost-effective compared to non-surgical interventions. These economic assessments models can inform helath policy decisions related to obesity
Bariatric Outcomes and Obesity Modeling: Study Meeting ( file )
1 edition published in 2010 in English and held by 0 libraries worldwide
This study sought to (1) define the clinical impact and economic burden of bariatric surgical procedures, and (2) estimate the cost-effectiveness and budgetary impact of obesity treatments when compared to no surgical intervention. We developed a cost-effectiveness model and a payer-based budget and fiscal impact tool to compare bariatric surgical procedures to non-operative approaches for maorbid obesity. Use of these economic models based on data from the Department of Defense (DOD) population found that all evaluated surgical interventions were cost-effective compared to non-surgical interventions. These economic assessments models can inform helath policy decisions related to obesity.l
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