PMID- 20964470
OWN - NLM
STAT- MEDLINE
DCOM- 20110203
LR  - 20211020
IS  - 1936-2692 (Electronic)
IS  - 1088-0224 (Print)
IS  - 1088-0224 (Linking)
VI  - 16
IP  - 10
DP  - 2010 Oct
TI  - Variation in prescription use and spending for lipid-lowering and diabetes 
      medications in the Veterans Affairs Healthcare System.
PG  - 741-50
AB  - OBJECTIVES: To examine variation in outpatient prescription use and spending for 
      hyperlipidemia and diabetes mellitus in the Veterans Affairs Healthcare System 
      (VA) and its association with quality measures for these conditions. STUDY 
      DESIGN: Cross-sectional. METHODS: We compared outpatient prescription use, 
      spending, and quality of care across 135 VA medical centers (VAMCs) in fiscal 
      year 2008, including 2.3 million patients dispensed lipid-lowering medications 
      and 981,031 patients dispensed diabetes medications. At each facility, we 
      calculated VAMC-level cost per patient for these medications, the proportion of 
      patients taking brand-name drugs, and Healthcare Effectiveness Data and 
      Information Set (HEDIS) scores for hyperlipidemia (low-density lipoprotein 
      cholesterol level <100 mg/dL) and for diabetes (glycosylated hemoglobin level >9% 
      or not measured). RESULTS: The median cost per patient for lipid-lowering agents 
      in fiscal year 2008 was $49.60 and varied from $39.68 in the least expensive 
      quartile of VAMCs to $69.57 in the most expensive quartile (P < .001). For 
      diabetes agents, the median cost per patient was $158.34 and varied from $123.34 
      in the least expensive quartile to $198.31 in the most expensive quartile (P < 
      .001). The proportion of patients dispensed brand-name oral drugs among these 
      classes in the most expensive quartile of VAMCs was twice that in the least 
      expensive quartile (P < .001). There was no correlation between VAMC-level 
      prescription spending and performance on HEDIS measures for lipid-lowering drugs 
      (r = 0.12 and r = 0.07) or for diabetes agents (r = -0.10). CONCLUSIONS: Despite 
      the existence of a closely managed formulary, significant variation in 
      prescription spending and use of brand-name drugs exists in the VA. Although we 
      could not explicitly risk-adjust, there appears to be no relationship between 
      prescription spending and quality of care.
FAU - Gellad, Walid F
AU  - Gellad WF
AD  - Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, 
      Pittsburgh, PA 15206, USA. walid.gellad@va.gov
FAU - Good, Chester B
AU  - Good CB
FAU - Lowe, John C
AU  - Lowe JC
FAU - Donohue, Julie M
AU  - Donohue JM
LA  - eng
GR  - KL2 RR024154/RR/NCRR NIH HHS/United States
GR  - KL2 RR024154-01/RR/NCRR NIH HHS/United States
GR  - KL2 TR000146/TR/NCATS NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PL  - United States
TA  - Am J Manag Care
JT  - The American journal of managed care
JID - 9613960
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Hypolipidemic Agents)
RN  - 0 (Prescription Drugs)
MH  - Confidence Intervals
MH  - Cross-Sectional Studies
MH  - Diabetes Mellitus/drug therapy/*economics
MH  - Economics, Pharmaceutical
MH  - Health Care Costs
MH  - Health Expenditures
MH  - Hospitals, Veterans/*economics/statistics & numerical data
MH  - Humans
MH  - Hyperlipidemias/*drug therapy/economics
MH  - Hypoglycemic Agents/*economics/therapeutic use
MH  - Hypolipidemic Agents/economics/*therapeutic use
MH  - Logistic Models
MH  - Odds Ratio
MH  - Outpatients/statistics & numerical data
MH  - Prescription Drugs/*economics
MH  - Statistics, Nonparametric
MH  - United States
MH  - United States Department of Veterans Affairs
PMC - PMC3096004
MID - NIHMS285336
EDAT- 2010/10/23 06:00
MHDA- 2011/02/04 06:00
PMCR- 2011/05/17
CRDT- 2010/10/23 06:00
PHST- 2010/10/23 06:00 [entrez]
PHST- 2010/10/23 06:00 [pubmed]
PHST- 2011/02/04 06:00 [medline]
PHST- 2011/05/17 00:00 [pmc-release]
AID - 12725 [pii]
PST - ppublish
SO  - Am J Manag Care. 2010 Oct;16(10):741-50.