Cost effectiveness and budget impact of natalizumab in patients with relapsing multiple sclerosis.

Background: Disease-modifying therapy (DMT) is the largest single-cost item that contributes to the total per-patient cost of multiple sclerosis (MS), a disabling disorder of the central nervous system. Natalizumab is the most recent DMT to be approved for the treatment of relapsing MS and may be an attractive alternative to interferon beta and glatiramer acetate (GA).

Objectives: To determine from the perspective of a United States payer (1) the incremental cost effectiveness of natalizumab compared with other DMTs and (2) the budgetary impact of utilization of natalizumab for the treatment of relapsing MS.

Provider organization performance assessment utilizing diabetes physician recognition program.

Objective: To examine the level of care in a large provider organization with respect to the Diabetes Physician Recognition Program (DPRP) standards of care and describe treatment patterns, diabetes-related complications, and achievement of clinical goals among patients stratified by glycemic control levels.

Study Design: Observational, retrospective, chart review study assessing care among patients with diabetes.

Methods: Diabetic patients aged > or =5 years who were prescribed insulin or oral hypoglycemics/antihyperglycemics for at least 12 months by 1 of 14 DPRP-participating physicians from the provider organization were eligible.

High-risk patients with hypertension: Are we doing enough?

Despite the increasing risk of cardiovascular disease, especially in patients with multiple risk factors, blood pressure (BP) control remains suboptimal. This study investigated real-world BP goal attainment and prescribing patterns for high-risk patients. A retrospective chart review study was conducted in patients treated by eight large primary care physician group practices between December 2003 and May 2006.

Impact of antidepressant drug adherence on comorbid medication use and resource utilization.

Background: Patients with depression are often nonadherent to therapy for depression and chronic comorbid conditions.

Methods: To determine whether improved antidepressant medication adherence is associated with an increased likelihood of chronic comorbid disease medication adherence and reduced medical costs, we conducted a retrospective study of patients initiating antidepressant drug therapy with evidence of dyslipidemia, coronary artery disease (CAD), or both; diabetes mellitus (DM); or CAD/dyslipidemia and DM identified from a claims database. Measures included antidepressant medication adherence, measured by medication possession ratio during 180 days without a 15-day gap before 90 days of therapy; comorbid medication adherence, measured by medication possession ratio during 1 year; and the association between improved antidepressant drug adherence and disease-specific and total medical costs.

Differences in compliance patterns across the selective serotonin reuptake inhibitors (SSRIs).

Objective: To evaluate differential compliance rates between immediate-release (IR) selective serotonin reuptake inhibitors (SSRI) and a controlled-release (CR) SSRI in patients initiating SSRI therapy.

Methods: A retrospective analysis of patients initiating treatment with SSRIs identified in the IHCIS National Managed Care Database between July 2001 and December 2002 was conducted. Logistic regression models were used to assess differences in 6-month compliance rates, controlling for age, gender, utilization of mental health specialty care services, titration rates, diagnoses, and comorbidities.

Implications of an SSRI generic step therapy pharmacy benefit design: an economic model in anxiety disorders.

As the antidepressant market continues to expand, it is important for healthcare decision makers to develop clinically and economically sound drug benefit designs. As such, the purpose of this study was to determine the economic implications of a generic step therapy (GST) formulary compared with an open formulary for selective serotonin reuptake inhibitors (SSRIs) in patients with anxiety disorders. A model simulating the SSRI treatment patterns of patients diagnosed with an anxiety disorder in a hypothetical health plan with 1 million members was developed.

Anxiety disorders in the 21st century: status, challenges, opportunities, and comorbidity with depression.

Anxiety disorders are highly prevalent in adults and often coexist with depression. Patients with anxiety commonly present to their primary care doctors, or in other medical settings, reflecting a high utilization of medical services. Furthermore, some patients initially complain of only somatic symptoms before they are ultimately diagnosed with a primary anxiety disorder.