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Effect of higher prescription co-pay...

Al-Zakwani, Ibrahim S.

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Effect of higher prescription co-payments on clinical outcomes in patients with hypercholesterolemia in a managed care organization.

紀錄類型:	書目-語言資料,印刷品 : Monograph/item
正題名/作者:	Effect of higher prescription co-payments on clinical outcomes in patients with hypercholesterolemia in a managed care organization./
作者:	Al-Zakwani, Ibrahim S.
面頁冊數:	124 p.
附註:	Adviser: Robert I. Field.
Contained By:	Dissertation Abstracts International65-12B.
標題:	Health Sciences, Health Care Management. -
電子資源:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3155917
ISBN:	9780496164417

Effect of higher prescription co-payments on clinical outcomes in patients with hypercholesterolemia in a managed care organization.
Al-Zakwani, Ibrahim S.

Effect of higher prescription co-payments on clinical outcomes in patients with hypercholesterolemia in a managed care organization. - 124 p.

Adviser: Robert I. Field.

Thesis (Ph.D.)--University of the Sciences in Philadelphia, 2005.

Prescription cost-sharing mechanisms have been demonstrated to reduce prescription utilization and expenditures. However, the literature evaluating the impact of prescription cost-control on actual clinical outcomes is largely unexplored. The aim of this research was to evaluate the effect of higher prescription co-payments on clinical outcomes in patients with hypercholesterolemia in a managed care organization. A retrospective, observational cohort analysis was conducted of pharmacy, medical, and laboratory claims database from a southeastern US health plan. Patients were included if they began statin therapy between 7/1/1999 and 6/30/2001, had no dyslipidemic therapy in the previous 6 months, had continuous health plan enrollment 6 months pre-index and 12 months post-index, and had both pre- and post-index lipid measurements. Patients were stratified into higher (≥

ISBN: 9780496164417Subjects--Topical Terms:

1017922
Health Sciences, Health Care Management.

Effect of higher prescription co-payments on clinical outcomes in patients with hypercholesterolemia in a managed care organization.
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245 1 0 $a Effect of higher prescription co-payments on clinical outcomes in patients with hypercholesterolemia in a managed care organization.
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520 $a Prescription cost-sharing mechanisms have been demonstrated to reduce prescription utilization and expenditures. However, the literature evaluating the impact of prescription cost-control on actual clinical outcomes is largely unexplored. The aim of this research was to evaluate the effect of higher prescription co-payments on clinical outcomes in patients with hypercholesterolemia in a managed care organization. A retrospective, observational cohort analysis was conducted of pharmacy, medical, and laboratory claims database from a southeastern US health plan. Patients were included if they began statin therapy between 7/1/1999 and 6/30/2001, had no dyslipidemic therapy in the previous 6 months, had continuous health plan enrollment 6 months pre-index and 12 months post-index, and had both pre- and post-index lipid measurements. Patients were stratified into higher (≥ $2 0) and lower (< $2 0) prescription co-payment cohorts. The primary endpoints were mean percent change in each of the lipid fractions (total cholesterol [TC], LDL-cholesterol [LDL-C], HDL-cholesterol [HDL-C], and triglycerides [TG]), NCEP-ATP-III (National Cholesterol Education Program) LDL-C goal attainment, and time to development of major adverse cardiac event (MACE). Statistical analyses were conducted using ordinary least squares, logistic, and Cox proportional hazard regression. A total of 5,476 patients were identified (< $2 0 = 3,157; ≥ $2 0 = 2,319). The higher prescription co-payment cohort was associated with a significantly greater adjusted mean percent reduction in LDL-C (-26.2% vs. -25.2%; p = 0.022) and a significantly greater adjusted mean percent increase in HDL-C (1.6% vs. 0.7%; p = 0.039) when compared to the lower prescription co-payment group. There were no significant differences in mean percent change in TC and TG as well as NCEP-ATP-III LDL-C goal attainment rates between the groups. However, patients in the higher prescription co-payment cohort were associated with higher MACE events compared to those in the lower prescription co-payment group (HR 1.37; 95% CI: 1.02 to 1.85; p = 0.36). These findings indicate an association between prescription cost-sharing and the most important outcome measure of all, actual cardiac events. However, the non-significant and counterintuitive findings of the intermediate lipid laboratory outcomes as well as the potential limitations, call for substantial further research into the relationship between prescription co-payment and MACE before any definitive conclusions are made.
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