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[PMID]:28457798
[Au] Autor:Tabit CE; Coplan MJ; Spencer KT; Alcain CF; Spiegel T; Vohra AS; Adelman D; Liao JK; Sanghani RM
[Ad] Endereço:Section of Cardiology, Department of Medicine, The University of Chicago Medical Center, Ill.
[Ti] Título:Cardiology Consultation in the Emergency Department Reduces Re-hospitalizations for Low-Socioeconomic Patients with Acute Decompensated Heart Failure.
[So] Source:Am J Med;130(9):1112.e17-1112.e31, 2017 Sep.
[Is] ISSN:1555-7162
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Re-hospitalization after discharge for acute decompensated heart failure is a common problem. Low-socioeconomic urban patients suffer high rates of re-hospitalization and often over-utilize the emergency department (ED) for their care. We hypothesized that early consultation with a cardiologist in the ED can reduce re-hospitalization and health care costs for low-socioeconomic urban patients with acute decompensated heart failure. METHODS: There were 392 patients treated at our center for acute decompensated heart failure who received standardized education and follow-up. Patients who returned to the ED received early consultation with a cardiologist; 392 patients who received usual care served as controls. Thirty- and 90-day re-hospitalization, ED re-visits, heart failure symptoms, mortality, and health care costs were recorded. RESULTS: Despite guideline-based education and follow-up, the rate of ED re-visits was not different between the groups. However, the rate of re-hospitalization was significantly lower in patients receiving the intervention compared with controls (odds ratio 0.592), driven by a reduction in the risk of readmission from the ED (0.56 vs 0.79, respectively). Patients receiving the intervention accumulated 14% fewer re-hospitalized days than controls and 57% lower 30-day total health care cost. Despite the reduction in health care resource consumption, mortality was unchanged. After accounting for the total cost of intervention delivery, the health care cost savings was substantially greater than the cost of intervention delivery. CONCLUSION: Early consultation with a cardiologist in the ED as an adjunct to guideline-based follow-up is associated with reduced re-hospitalization and health care cost for low-socioeconomic urban patients with acute decompensated heart failure.
[Mh] Termos MeSH primário: Cardiologia/normas
Serviço Hospitalar de Emergência/utilização
Insuficiência Cardíaca/terapia
Educação de Pacientes como Assunto/organização & administração
Readmissão do Paciente/estatística & dados numéricos
[Mh] Termos MeSH secundário: Doença Aguda
Idoso
Cardiologia/economia
Cardiologia/métodos
Estudos de Casos e Controles
Chicago
Controle de Custos/métodos
Controle de Custos/normas
Serviço Hospitalar de Emergência/economia
Serviço Hospitalar de Emergência/organização & administração
Feminino
Insuficiência Cardíaca/economia
Seres Humanos
Masculino
Meia-Idade
Estudos de Casos Organizacionais
Alta do Paciente/economia
Alta do Paciente/normas
Alta do Paciente/estatística & dados numéricos
Educação de Pacientes como Assunto/economia
Educação de Pacientes como Assunto/métodos
Readmissão do Paciente/economia
Guias de Prática Clínica como Assunto
Pontuação de Propensão
Encaminhamento e Consulta/economia
Encaminhamento e Consulta/normas
Estudos Retrospectivos
Fatores Socioeconômicos
Centros de Atenção Terciária/economia
Centros de Atenção Terciária/organização & administração
Saúde da População Urbana/economia
Saúde da População Urbana/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180311
[Lr] Data última revisão:
180311
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE


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[PMID]:28464930
[Au] Autor:Hind D; Reeves BC; Bathers S; Bray C; Corkhill A; Hayward C; Harper L; Napp V; Norrie J; Speed C; Tremain L; Keat N; Bradburn M
[Ad] Endereço:CTRU, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK. d.hind@sheffield.ac.uk.
[Ti] Título:Comparative costs and activity from a sample of UK clinical trials units.
[So] Source:Trials;18(1):203, 2017 May 02.
[Is] ISSN:1745-6215
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The costs of medical research are a concern. Clinical Trials Units (CTUs) need to better understand variations in the costs of their activities. METHODS: Representatives of ten CTUs and two grant-awarding bodies pooled their experiences in discussions over 1.5 years. Five of the CTUs provided estimates of, and written justification for, costs associated with CTU activities required to implement an identical protocol. The protocol described a 5.5-year, nonpharmacological randomized controlled trial (RCT) conducted at 20 centres. Direct and indirect costs, the number of full time equivalents (FTEs) and the FTEs attracting overheads were compared and qualitative methods (unstructured interviews and thematic analysis) were used to interpret the results. Four members of the group (funding-body representatives or award panel members) reviewed the justification statements for transparency and information content. Separately, 163 activities common to trials were assigned to roles used by nine CTUs; the consistency of role delineation was assessed by Cohen's κ. RESULTS: Median full economic cost of CTU activities was £769,637 (range: £661,112 to £1,383,323). Indirect costs varied considerably, accounting for between 15% and 59% (median 35%) of the full economic cost of the grant. Excluding one CTU, which used external statisticians, the total number of FTEs ranged from 2.0 to 3.0; total FTEs attracting overheads ranged from 0.3 to 2.0. Variation in directly incurred staff costs depended on whether CTUs: supported particular roles from core funding rather than grants; opted not to cost certain activities into the grant; assigned clerical or data management tasks to research or administrative staff; employed extensive on-site monitoring strategies (also the main source of variation in non-staff costs). Funders preferred written justifications of costs that described both FTEs and indicative tasks for funded roles, with itemised non-staff costs. Consistency in role delineation was fair (κ = 0.21-0.40) for statisticians/data managers and poor for other roles (κ < 0.20). CONCLUSIONS: Some variation in costs is due to factors outside the control of CTUs such as access to core funding and levels of indirect costs levied by host institutions. Research is needed on strategies to control costs appropriately, especially the implementation of risk-based monitoring strategies.
[Mh] Termos MeSH primário: Estudos Multicêntricos como Assunto/economia
Ensaios Clínicos Controlados Aleatórios como Assunto/economia
Projetos de Pesquisa
Apoio à Pesquisa como Assunto/economia
[Mh] Termos MeSH secundário: Orçamentos
Controle de Custos
Análise Custo-Benefício
Seres Humanos
Reino Unido
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.1186/s13063-017-1934-3


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[PMID]:29437063
[Au] Autor:Pang EQ; Truntzer J; Baker L; Harris AHS; Gardner MJ; Kamal RN
[Ad] Endereço:Stanford Medicine, Orthopaedic Surgery, 300 Pasteur Drive, Room R144, Stanford, California 94305-5341, USA.
[Ti] Título:Cost minimization analysis of the treatment of distal radial fractures in the elderly.
[So] Source:Bone Joint J;100-B(2):205-211, 2018 Feb.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: The aim of this study was to test the null hypothesis that there is no difference, from the payer perspective, in the cost of treatment of a distal radial fracture in an elderly patient, aged > 65 years, between open reduction and internal fixation (ORIF) and closed reduction (CR). MATERIALS AND METHODS: Data relating to the treatment of these injuries in the elderly between January 2007 and December 2015 were extracted using the Humana and Medicare Advantage Databases. The primary outcome of interest was the cost associated with treatment. Secondary analysis included the cost of common complications. Statistical analysis was performed using a non-parametric -test and chi-squared test. RESULTS: Our search yielded 8924 patients treated with ORIF and 5629 patients treated with CR. The mean cost of an uncomplicated ORIF was more than a CR ($7749 $2161). The mean additional cost of a complication in the ORIF group was greater than in the CR group ($1853 $1362). CONCLUSION: These findings show that there are greater payer fees associated with ORIF than CR in patients aged > 65 years with a distal radial fracture. CR may be a higher-value intervention in these patients. Cite this article: 2018;100-B:205-11.
[Mh] Termos MeSH primário: Controle de Custos
Fixação de Fratura/economia
Fixação de Fratura/métodos
Fraturas do Rádio/cirurgia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Masculino
Complicações Pós-Operatórias/economia
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180214
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.100B2.BJJ-2017-0358.R1


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[PMID]:29298152
[Au] Autor:Fuse Brown EC; Sarpatwari A
[Ad] Endereço:From Georgia State University College of Law, Atlanta (E.C.F.B.); and the Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.S.).
[Ti] Título:Removing ERISA's Impediment to State Health Reform.
[So] Source:N Engl J Med;378(1):5-7, 2018 Jan 04.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Employee Retirement Income Security Act
Reforma dos Serviços de Saúde/legislação & jurisprudência
Planos Governamentais de Saúde/legislação & jurisprudência
[Mh] Termos MeSH secundário: Controle de Custos
Custos de Cuidados de Saúde
Governo Estadual
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180118
[Lr] Data última revisão:
180118
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180104
[St] Status:MEDLINE


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[PMID]:29272908
[Au] Autor:Zuckerman S; Skopec L; Guterman S
[Ad] Endereço:Health Policy Center, Urban Institute.
[Ti] Título:Do Medicare Advantage Plans Minimize Costs? Investigating the Relationship Between Benchmarks, Costs, and Rebates.
[So] Source:Issue Brief (Commonw Fund);2017:1-11, 2017 Dec 01.
[Is] ISSN:1558-6847
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Issue: Medicare Advantage (MA), the program that allows people to receive their Medicare benefits through private health plans, uses a benchmark-and-bidding system to induce plans to provide benefits at lower costs. However, prior research suggests medical costs, profits, and other plan costs are not as low under this system as they might otherwise be. Goal: To examine how well the current system encourages MA plans to bid their lowest cost by examining the relationship between costs and bonuses (rebates) and the benchmarks Medicare uses in determining plan payments. Methods: Regression analysis using 2015 data for HMO and local PPO plans. Findings: Costs and rebates are higher for MA plans in areas with higher benchmarks, and plan costs vary less than benchmarks do. A one-dollar increase in benchmarks is associated with 32-cent-higher plan costs and a 52-cent-higher rebate, even when controlling for market and plan factors that can affect costs. This suggests the current benchmark-and-bidding system allows plans to bid higher than local input prices and other market conditions would seem to warrant. Conclusion: To incentivize MA plans to maximize efficiency and minimize costs, Medicare could change the way benchmarks are set or used.
[Mh] Termos MeSH primário: Benchmarking/estatística & dados numéricos
Controle de Custos
Custos de Cuidados de Saúde/estatística & dados numéricos
Medicare Part C/economia
Medicare Part C/estatística & dados numéricos
[Mh] Termos MeSH secundário: Seres Humanos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:171223
[St] Status:MEDLINE


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[PMID]:29206787
[Au] Autor:Arshi A; Leong NL; D'Oro A; Wang C; Buser Z; Wang JC; Jones KJ; Petrigliano FA; SooHoo NF
[Ad] Endereço:Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
[Ti] Título:Outpatient Total Knee Arthroplasty Is Associated with Higher Risk of Perioperative Complications.
[So] Source:J Bone Joint Surg Am;99(23):1978-1986, 2017 Dec 06.
[Is] ISSN:1535-1386
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: As concerns regarding health-care expenditure in the U.S. remain at the national forefront, outpatient arthroplasty is an appealing option for carefully selected patient populations. The purpose of this study was to determine the nationwide trends and complication rates associated with outpatient total knee arthroplasty (TKA) in comparison with standard inpatient TKA. METHODS: We performed a retrospective review of the Humana subset of the PearlDiver Patient Record Database to identify patients who had undergone TKA (Current Procedural Terminology [CPT] code 27447) as either outpatients or inpatients from 2007 to 2015. The incidence of perioperative medical and surgical complications was determined by querying for relevant International Classification of Diseases, Ninth Revision (ICD-9) and CPT codes. Multivariate logistic regression analysis adjusted for age, sex, and Charlson Comorbidity Index (CCI) was used to calculate odds ratios (ORs) of complications among outpatients relative to inpatients treated with TKA. RESULTS: Cohorts of 4,391 patients who underwent outpatient TKA and 128,951 patients who underwent inpatient TKA were identified. The median age was in the 70 to 74-year age group in both cohorts. The incidence of outpatient TKA increased across the study period (R = 0.60, p = 0.015). After adjustment for age, sex, and CCI, outpatient TKAs were found to more likely be followed by tibial and/or femoral component revision due to a noninfectious cause (OR = 1.22, 95% confidence interval [CI] = 1.01 to 1.47; p = 0.039), explantation of the prosthesis (OR = 1.35, CI = 1.07 to 1.72; p = 0.013), irrigation and debridement (OR = 1.50, CI = 1.28 to 1.77; p < 0.001), and stiffness requiring manipulation under anesthesia (OR = 1.28, CI = 1.17 to 1.40; p < 0.001) within 1 year. Outpatient TKA was also more frequently associated with postoperative deep vein thrombosis (OR = 1.42, CI = 1.25 to 1.63; p < 0.001) and acute renal failure (OR = 1.13, CI = 1.01 to 1.25; p = 0.026). CONCLUSIONS: With the potential to minimize arthroplasty costs among healthy patients, outpatient TKA is an increasingly popular option. Nationwide data from a private insurance database demonstrated a higher risk of perioperative surgical and medical complications including component failure, surgical site infection, knee stiffness, and deep vein thrombosis. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
[Mh] Termos MeSH primário: Assistência Ambulatorial
Artroplastia do Joelho
Complicações Intraoperatórias/epidemiologia
Complicações Pós-Operatórias/epidemiologia
[Mh] Termos MeSH secundário: Idoso
Assistência Ambulatorial/economia
Artroplastia do Joelho/economia
Comorbidade
Controle de Custos
Feminino
Seres Humanos
Incidência
Complicações Intraoperatórias/economia
Masculino
Complicações Pós-Operatórias/economia
Estudos Retrospectivos
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171208
[Lr] Data última revisão:
171208
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE
[do] DOI:10.2106/JBJS.16.01332


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[PMID]:29068183
[Au] Autor:Edwards E
[Ad] Endereço:National Health Law Program, Carrboro, North Carolina.
[Ti] Título:Assessing Changes to Medicaid Managed Care Regulations: Facilitating Integration of Physical and Behavioral Health Care.
[So] Source:Issue Brief (Commonw Fund);2017:1-7, 2017 Oct 01.
[Is] ISSN:1558-6847
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Issue: As states consider how to effectively control Medicaid costs, many are looking to integrate behavioral and medical care, including long-term services and supports, particularly for individuals with complex needs. Goal: To summarize how recent federal regulations are encouraging an integrated approach to behavioral and physical health care. Findings and Conclusions: Two recent federal rules issued in 2016 are facilitating the transition to integrated care models: the Medicaid managed care rule and the Medicaid managed care mental health parity rule. These changes may not spell the end of fragmented systems, but they certainly do not support a status quo approach to care. While the regulations do not specifically address integrated care, they should facilitate and, in some instances, encourage, state movement to integrated care for Medicaid participants.
[Mh] Termos MeSH primário: Prestação Integrada de Cuidados de Saúde/organização & administração
Programas de Assistência Gerenciada/organização & administração
Medicaid/organização & administração
Serviços de Saúde Mental/organização & administração
[Mh] Termos MeSH secundário: Controle de Custos
Disparidades em Assistência à Saúde
Seres Humanos
Reembolso de Seguro de Saúde
Assistência de Longa Duração/organização & administração
Mecanismo de Reembolso
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:171027
[St] Status:MEDLINE


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[PMID]:28990743
[Au] Autor:Health Resources and Services Administration, HHS
[Ti] Título:Drug Pricing Program Ceiling Price and Manufacturer Civil Monetary Penalties Regulation. Final rule; further delay of effective date.
[So] Source:Fed Regist;82(188):45511-4, 2017 Sep 29.
[Is] ISSN:0097-6326
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The Health Resources and Services Administration (HRSA) administers section 340B of the Public Health Service Act (PHSA), known as the "340B Drug Pricing Program" or the "340B Program." HRSA published a final rule on January 5, 2017, that set forth the calculation of the ceiling price and application of civil monetary penalties. The final rule applied to all drug manufacturers that are required to make their drugs available to covered entities under the 340B Program. On August 21, 2017, HHS solicited comments on further delaying the effective date of the January 5, 2017, final rule to July 1, 2018 (82 FR 39553). HHS proposed this action to allow a more deliberate process of considering alternative and supplemental regulatory provisions and to allow for sufficient time for additional rulemaking. After consideration of the comments received on the proposed rule, HHS is delaying the effective date of the January 5, 2017, final rule, to July 1, 2018.
[Mh] Termos MeSH primário: Custos de Medicamentos/legislação & jurisprudência
[Mh] Termos MeSH secundário: Controle de Custos/legislação & jurisprudência
Programas Governamentais/legislação & jurisprudência
Seres Humanos
Legislação de Medicamentos/economia
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:171011
[St] Status:MEDLINE


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[PMID]:28771405
[Au] Autor:Nakamura MM; Zaslavsky AM; Toomey SL; Petty CR; Bryant MC; Geanacopoulos AT; Jha AK; Schuster MA
[Ad] Endereço:Divisions of General Pediatrics and mari.nakamura@childrens.harvard.edu.
[Ti] Título:Pediatric Readmissions After Hospitalizations for Lower Respiratory Infections.
[So] Source:Pediatrics;140(2), 2017 Aug.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND OBJECTIVE: Lower respiratory infections (LRIs) are among the most common reasons for pediatric hospitalization and among the diagnoses with the highest number of readmissions. Characterizing LRI readmissions would help guide efforts to prevent them. We assessed variation in pediatric LRI readmission rates, risk factors for readmission, and readmission diagnoses. METHODS: We analyzed 2008-2009 Medicaid Analytic eXtract data for patients <18 years of age in 26 states. We identified LRI hospitalizations based on a primary diagnosis of bronchiolitis, influenza, or community-acquired pneumonia or a secondary diagnosis of one of these LRIs plus a primary diagnosis of asthma, respiratory failure, or sepsis/bacteremia. Readmission rates were calculated as the proportion of hospitalizations followed by ≥1 unplanned readmission within 30 days. We used logistic regression with fixed effects for patient characteristics and a hospital random intercept to case-mix adjust rates and assess risk factors. RESULTS: Of 150 590 LRI hospitalizations, 8233 (5.5%) were followed by ≥1 readmission. The median adjusted hospital readmission rate was 5.2% (interquartile range: 5.1%-5.4%), and rates varied across hospitals ( < .0001). Infants (patients <1 year of age), boys, and children with chronic conditions were more likely to be readmitted. The most common primary diagnoses on readmission were LRIs (48.2%), asthma (10.0%), fluid/electrolyte disorders (3.4%), respiratory failure (3.3%), and upper respiratory infections (2.7%). CONCLUSIONS: LRI readmissions are common and vary across hospitals. Multiple risk factors are associated with readmission, indicating potential targets for strategies to reduce readmissions. Readmission diagnoses sometimes seem related to the original LRI.
[Mh] Termos MeSH primário: Bronquiolite/economia
Bronquiolite/terapia
Infecções Comunitárias Adquiridas/economia
Infecções Comunitárias Adquiridas/terapia
Influenza Humana/economia
Influenza Humana/terapia
Medicaid/economia
Patient Protection and Affordable Care Act/economia
Readmissão do Paciente/economia
Pneumonia/economia
Pneumonia/terapia
[Mh] Termos MeSH secundário: Fatores Etários
Bronquiolite/prevenção & controle
Infecções Comunitárias Adquiridas/prevenção & controle
Controle de Custos
Custos de Cuidados de Saúde
Hospitais Pediátricos/economia
Seres Humanos
Lactente
Recém-Nascido
Doenças do Prematuro/economia
Doenças do Prematuro/prevenção & controle
Doenças do Prematuro/terapia
Influenza Humana/prevenção & controle
Pneumonia/prevenção & controle
Fatores de Risco
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171110
[Lr] Data última revisão:
171110
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170804
[St] Status:MEDLINE


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[PMID]:28765380
[Au] Autor:Cohen E; Hall M; Lopert R; Bruen B; Chamberlain LJ; Bardach N; Gedney J; Zima BT; Berry JG
[Ad] Endereço:Department of Pediatrics and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario; eyal.cohen@sickkids.ca.
[Ti] Título:High-Expenditure Pharmaceutical Use Among Children in Medicaid.
[So] Source:Pediatrics;140(3), 2017 Sep.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND OBJECTIVES: Medication use may be a target for quality improvement, cost containment, and research. We aimed to identify medication classes associated with the highest expenditures among pediatric Medicaid enrollees and to characterize the demographic, clinical, and health service use of children prescribed these medications. METHODS: Retrospective, cross-sectional study of 3 271 081 Medicaid-enrolled children. Outpatient medication spending among high-expenditure medication classes, defined as the 10 most expensive among 261 mutually exclusive medication classes, was determined by using transaction prices paid to pharmacies by Medicaid agencies and managed care plans among prescriptions filled and dispensed in 2013. RESULTS: Outpatient medications accounted for 16.6% of all Medicaid expenditures. The 10 most expensive medication classes accounted for 63.9% of all medication expenditures. Stimulants (amphetamine-type) accounted for both the highest proportion of expenditures (20.6%) and days of medication use (14.0%) among medication classes. Users of medications in the 10 highest-expenditure classes were more likely to have a chronic condition of any complexity (77.9% vs 41.6%), a mental health condition (35.7% vs 11.9%), or a complex chronic condition (9.8% vs 4.3%) than other Medicaid enrollees (all < .001). The 4 medications with the highest spending were all psychotropic medications. Polypharmacy was common across all high-expenditure classes. CONCLUSIONS: Medicaid expenditure on pediatric medicines is concentrated among a relatively small number of medication classes most commonly used in children with chronic conditions. Interventions to improve medication safety and effectiveness and contain costs may benefit from better delineation of the appropriate prescription of these medications.
[Mh] Termos MeSH primário: Medicaid/economia
Medicamentos sob Prescrição/economia
[Mh] Termos MeSH secundário: Criança
Doença Crônica/tratamento farmacológico
Controle de Custos
Estudos Transversais
Feminino
Seres Humanos
Masculino
Programas de Assistência Gerenciada/economia
Transtornos Mentais/tratamento farmacológico
Polimedicação
Psicotrópicos/economia
Psicotrópicos/uso terapêutico
Estudos Retrospectivos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Prescription Drugs); 0 (Psychotropic Drugs)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170920
[Lr] Data última revisão:
170920
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170803
[St] Status:MEDLINE



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