The h-e-B value-based health management program: impact on asthma medication adherence and healthcare cost.

Background: Recent publications have shown that copayment reductions increase medication adherence above the effects of existing disease management programs, demonstrating an additive effect of combining a value-based insurance design with a disease management program. This effect, however, has yet to be demonstrated for medications used for the treatment of asthma.

Objective: To evaluate the impact of a value-based health management asthma program-which included providing patient education and lowering copayments for select asthma controller medications-on medication adherence and healthcare utilization and costs.

Private health plans perspectives: electronic personal health records and electronic prescribing.

Background: Patients, payers, public health researchers, medical economists, and policymakers have all called for aggressive deployment of information technologies to support the management of health records and prescriptions. In response, payers of all types have been making investments in electronic systems.

Objectives: To understand, analyze, and quantify current private payer involvement in electronic personal health records and electronic prescribing development and implementation.

5-Alpha reductase inhibitors in men with an enlarged prostate: an evaluation of outcomes and therapeutic alternatives.

This article presents background information and highlights key findings from a managed care perspective related to enlarged prostate (EP) in Medicare-eligible patients. This article does not provide a comprehensive review of EP but instead attempts to increase the current understanding of EP through discussion of its prevalence in men aged > or =65 years, its associated economic burden, and some available treatment options. This supplement includes 3 additional articles, all of which present data from a naturalistic, managed care setting.

Efficacy of vardenafil for the treatment of erectile dysfunction in men with hypertension: a meta-analysis of clinical trial data.

Objective: To review the evidence evaluating the efficacy of vardenafil in subgroups of hypertensive patients with erectile dysfunction (ED).

Methods: Meta-analysis of randomized, double-blinded, placebo-controlled, flexible-dose vardenafil clinical trials that were >or=12 weeks in duration evaluated men with a >or=6-month history of ED and required a >or=50% failure rate in baseline sexual attempts. The primary endpoints analyzed were the erectile function domain of the International Index of Erectile Function questionnaire (IIEF-EF) and Sexual Encounter Profile questions 2 (SEP2) and 3 (SEP3).

Medical therapy for benign prostatic hyperplasia--present and future impact.

The purpose of this manuscript is to provide clinicians, health plan decision makers, and policy makers with highlights of key findings pertaining to our current understanding of the condition of enlarged prostate (EP) from a managed care perspective. This includes a brief discussion regarding the prevalence and economic burden of EP, followed by a review of clinical characteristics and pathophysiology, with the final section on treatment approaches with a focus on pharmacologic options. This supplement is not intended to be a comprehensive review of EP, because many review articles on this subject are available elsewhere.

Methods for evaluating patient adherence to antidepressant therapy: a real-world comparison of adherence and economic outcomes.

Objective: The objective of this study was to differentiate between 3 measures of antidepressant adherence with regard to the number of patients deemed adherent to therapy and the association between adherence and resource utilization.

Design And Setting: The authors conducted a retrospective study of patients initiating selective serotonin reuptake inhibitor (SSRI) therapy for depression and/or anxiety between July 2001 and June 2002 in a large national managed care database.

Main Outcome Measures: Rates of 6-month SSRI adherence were measured by 3 different metrics: length of therapy (LOT), medication possession ratio (MPR), and combined MPR/LOT.

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.

Relationship of total health care charges to selective serotonin reuptake inhibitor utilization patterns including the length of antidepressant therapy--results from a managed care administrative claims database.

Objective: Administrative claims data analysis performed in the early 1990s found lower total medical costs for patients with depression who remained on antidepressant therapy with selective serotonin reuptake inhibitors (SSRIs) for at least 90 days compared with patients who discontinued therapy prior to 60 days. Over the past decade, many changes in the health care system have occurred that might impact the reproducibility of these findings. The purpose of this study was to investigate the association between SSRI utilization patterns and the use of health care services in the managed care environment.