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Effects of two-tier prescription dru...

Wang, Huihui.

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Effects of two-tier prescription drug copayments on prescription drug use and expenditures among health maintenance organization commercial enrollees with diabetes.

紀錄類型:	書目-語言資料,印刷品 : Monograph/item
正題名/作者:	Effects of two-tier prescription drug copayments on prescription drug use and expenditures among health maintenance organization commercial enrollees with diabetes./
作者:	Wang, Huihui.
面頁冊數:	149 p.
附註:	Adviser: Teh-wei Hu.
Contained By:	Dissertation Abstracts International69-09B.
標題:	Health Sciences, Health Care Management. -
電子資源:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3331835
ISBN:	9780549835288

Effects of two-tier prescription drug copayments on prescription drug use and expenditures among health maintenance organization commercial enrollees with diabetes.
Wang, Huihui.

Effects of two-tier prescription drug copayments on prescription drug use and expenditures among health maintenance organization commercial enrollees with diabetes. - 149 p.

Adviser: Teh-wei Hu.

Thesis (Ph.D.)--University of California, Berkeley, 2008.

Background. There is limited information about how patient out-of-pocket costs might affect drug use and expenditures over time.

ISBN: 9780549835288Subjects--Topical Terms:

1017922
Health Sciences, Health Care Management.

Effects of two-tier prescription drug copayments on prescription drug use and expenditures among health maintenance organization commercial enrollees with diabetes.
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100 1 $a Wang, Huihui. $3 1270973
245 1 0 $a Effects of two-tier prescription drug copayments on prescription drug use and expenditures among health maintenance organization commercial enrollees with diabetes.
300 $a 149 p.
500 $a Adviser: Teh-wei Hu.
500 $a Source: Dissertation Abstracts International, Volume: 69-09, Section: B, page: 5303.
502 $a Thesis (Ph.D.)--University of California, Berkeley, 2008.
520 $a Background. There is limited information about how patient out-of-pocket costs might affect drug use and expenditures over time.
520 $a Methods. In a natural experiment (2001-2005), this study examined changes in mean annual drug expenditures for all drugs and four major essential drug therapies (oral antidiabetic, insulin, antihypertensive and antidyslipidemia drugs), and out-of-pocket drug expenditures. Drug expenditures included drug purchase cost and dispensing cost, and were standardized to adjust for drug price changes over time. This study also examined changes in mean annual days supplied of the major essential drug therapies. All 8224 subjects were commercially insured Health Maintenance Organization (HMO) enrollees with diabetes in January 2001, age 18+ years. Starting in 2002, 66% of subjects paid $1 5 for brand-name drugs and $5 for generics (two-tier group); while 34% had no changes (one-tier group). This study used Generalized Linear Models (GLM) with generalized estimation equation approaches. For outcomes with many zeros, both one-part and two-part models were implemented. These models included a number of patient socio-demographic characteristics, clinical characteristics, secular trends (yearly indicators) and group-year interactions.
520 $a Results. This study reported difference-in-difference estimates (two-tier vs. one-tier for each post-treatment year relative to the baseline year, 2001) based on model results and mean values of covariates. For mean annual total drug expenditures, they were - $4 6.9, - $5 3.3, - $7 7.5 and - $8 1.9 respectively; for mean annual oral antidiabetic drug expenditures, they were - $2 3.2, - $2 7.2, - $2 1.4 and - $2 0.0. These estimates were statistically significant (alpha=0.05). This study did not find systematic effects on antidyslipidemia, antihypertensive and insulin drug expenditures. There was no evidence of decreased days supplied of major essential drug therapies for diabetes patients, except a temporary decrease in days supplied of oral antidiabetic drugs in 2002.
520 $a Conclusions. Two-tier copayments were associated with persistent decreases in both total drug expenditures and oral antidiabetic drug expenditures among patients with diabetes during the first four years with two-tier copayments. Two-tier copayments seemed to have decreased drug expenditures without significantly affecting days supplied of the major essential drug therapies. Additional research need to better understand underlying mechanisms of decreases in oral antidiabetic drug expenditures and clinical implications related to two-tier copayments.
590 $a School code: 0028.
650 4 $a Health Sciences, Health Care Management. $3 1017922
650 4 $a Health Sciences, Pharmacy. $3 1017737
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710 2 0 $a University of California, Berkeley. $3 687832
773 0 $t Dissertation Abstracts International $g 69-09B.
790 $a 0028
790 1 0 $a Hu, Teh-wei, $e advisor
791 $a Ph.D.
792 $a 2008
856 4 0 $u http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3331835