PMID- 14613451
OWN - NLM
STAT- MEDLINE
DCOM- 20031210
LR  - 20230823
IS  - 1083-4087 (Print)
IS  - 1944-706X (Electronic)
IS  - 1083-4087 (Linking)
VI  - 9
IP  - 4
DP  - 2003 Jul-Aug
TI  - Pharmacoeconomic modeling of prior-authorization intervention for COX-2 specific 
      inhibitors in a 3-tier copay plan.
PG  - 327-34
LID - 10.18553/jmcp.2003.9.4.327
AB  - OBJECTIVE: To determine from a health plan perspective the cost-effectiveness of 
      cyclooxygenase-2 (COX-2) specific inhibitors, with and without a 
      prior-authorization (PA) process. METHODS: A modeling exercise was employed, 
      based on prescription drug claims for a managed care organization with 3.8 
      million health maintenance organization (HMO) and preferred provider organization 
      (PPO) members. Drug claims revealed 96154 members (2.9% of the 3.3 million 
      members with a pharmacy benefit) who received either one or more prescriptions 
      for a COX-2 drug or a nonspecific nonsteroidal anti-inflammatory drug (NSAID). 
      These patients were stratified into 2 groups for further analysis, those having a 
      concurrent proton pump inhibitor (PPI) and those without a concurrent PPI. 
      Decision analysis was used to estimate the cost-effectiveness of COX-2 therapy. 
      Actual health plan drug claims data were used to determine utilization and 
      prescribing patterns of nonspecific NSAIDs, COX-2 specific inhibitors, and PPIs. 
      Results from the literature from 8 clinical trials were employed to determine the 
      probability of a serious gastrointestinal (GI) event. Cost-effectiveness analysis 
      (CEA) was used to determine the cost of each therapy, including the predicted 
      cost to treat a serious GI event in a drug benefit design with PA versus a 
      benefit design without PA. RESULTS: Cost-effectiveness analysis (CEA) showed that 
      the cost per success no serious GI event) for Cox-2 specific inhibitors with PA 
      was US dollars 278 versus US dollars 422 without PA. CONCLUSIONS: The one-year 
      model predicted that costs associated with an increase in COX-2 utilization after 
      removal of PA would exceed the costs to administer PA and treat NSAID-related 
      serious GI events in the managed care population. Based upon this CEA, PA appears 
      to be an effective tool to manage COX-2 pharmacy costs. Further examination of 
      the medical claims would be useful to validate the assumed GI event rates with or 
      without PA and to further demonstrate more definitively the value of a PA program 
      for COX-2 drugs.
FAU - Stacy, Jane
AU  - Stacy J
AD  - Humana Inc, Corporate Pharmacy Management, St, Louisville, KY 40202, USA.
FAU - Shaw, Elizabeth
AU  - Shaw E
FAU - Arledge, Michele D
AU  - Arledge MD
FAU - Howell-Smith, Donna
AU  - Howell-Smith D
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Manag Care Pharm
JT  - Journal of managed care pharmacy : JMCP
JID - 9605854
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 0 (Cyclooxygenase Inhibitors)
SB  - IM
EIN - J Manag Care Pharm. 2004 Jan-Feb;10(1):87
CIN - J Manag Care Pharm. 2003 Nov-Dec;9(6):576; author reply 577. PMID: 14664672
CIN - J Manag Care Pharm. 2004 Jul-Aug;10(4):356. PMID: 15298534
MH  - Anti-Inflammatory Agents, Non-Steroidal/adverse effects/*economics/therapeutic 
      use
MH  - *Cost-Benefit Analysis
MH  - Cyclooxygenase Inhibitors/adverse effects/*economics/therapeutic use
MH  - *Economics, Pharmaceutical
MH  - Health Maintenance Organizations/*economics
MH  - Humans
MH  - Peptic Ulcer/chemically induced
MH  - Preferred Provider Organizations/*economics
MH  - Probability
PMC - PMC10437282
EDAT- 2003/11/14 05:00
MHDA- 2003/12/12 05:00
PMCR- 2003/07/01
CRDT- 2003/11/14 05:00
PHST- 2003/11/14 05:00 [pubmed]
PHST- 2003/12/12 05:00 [medline]
PHST- 2003/11/14 05:00 [entrez]
PHST- 2003/07/01 00:00 [pmc-release]
AID - 2003(9)4: 327-334 [pii]
AID - 10.18553/jmcp.2003.9.4.327 [doi]
PST - ppublish
SO  - J Manag Care Pharm. 2003 Jul-Aug;9(4):327-34. doi: 10.18553/jmcp.2003.9.4.327.