Racial/ethnic disparities in access to prescription drugs during early years of drug products' life cycles
Abstract
Objectives: To determine whether there are racial/ethnic disparities in the utilization of all new prescription drugs, and new, essential drugs. Methodology: The main data source was Medical Expenditure Panel Survey (1996--2001). Drugs were considered "new" if they had been in the market for less than six years. They were considered essential if at least four out of five experts considered them "essential". A negative binomial model was used to test the disparities in the average numbers of all new prescribed medicines or new, essential prescribed medicines across racial/ethnic groups when controlling for socioeconomic confounders. Sensitivity analyses were performed using variable definitions for the number of years post-launch that a drug is considered new and using relaxed criterion for essential drugs. Results: Among 47,115 prescription users, 31,853 were non-Hispanic whites, 5,904 were non-Hispanic blacks, and 7,337 were white Hispanics. The disparities in the use of all new drugs generally were significant between non-Hispanic whites and non-Hispanic blacks both before and after adjusting for confounding factors; this aspect of disparities were significant between non-Hispanic whites and white Hispanics before adjustment but they were not always significant afterwards. The disparities in the use of new, essential drugs were not significant between non-Hispanic whites and non-Hispanic blacks before adjusting for confounding factors but they were significant afterwards; this aspect of disparities between non-Hispanics whites and white Hispanics were significant before the adjustment but they generally were not significant afterwards. Gaps in the use of new, essential drugs was narrower than gaps in the use of all new drugs. Generosity of drug coverage and self-perceived worse health status had positive effects on the use of all new drugs and new, essential drugs. Sensitivity analyses reported similar results. Conclusions: There are smaller racial/ethnic disparities in the use of all new, essential drugs than the use of all new drugs. Larger share of ethnic disparities is accounted for by socioeconomic factors than racial disparities. The generosity of drug insurance coverage and self-perceived worse health status are positively correlated with the use of all new drugs and new, essential drugs.Description
University of Maryland, Baltimore. Pharmaceutical Health Services Research. Ph.D. 2005Keyword
Health Sciences, PharmacyHealth Sciences, Public Health
Health Sciences, Health Care Management
Drug Prescriptions
Drugs, Essential
Healthcare Disparities
Prescription Drugs
Identifier to cite or link to this item
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The impact of the state of Maryland's Medicaid mental health carve-out on access-to-care for patients in a suburban health care systemCorey-Lisle, Patricia Katherine; Trinkoff, Alison M. (2000)In recent years, providing care for individuals with severe mental illness has consumed increasing state and federal financial resources, with State Medicaid systems bearing the heaviest burden. Managed care strategies have been initiated by public mental health systems as a mechanism to control expenses. The state of Maryland implemented a mental health carve-out on July 1, 1997. The purpose of the present study is to describe the effects of the carve-out on access-to-care for individuals using emergency department services in one suburban health care system. Data for this study included all episodes of emergency crisis care in pre-implementation (1996-1997) and post-implementation (1998-1999) time periods. These data were examined within the context of the Behavioral Model of Health Service Use (Andersen, 1995) to describe the interrelationships among external environment, predisposing characteristics, and enabling resources on use of health services. Use of health services was operationalized by four outcomes: disposition, length of stay, number of visits, and recidivism. There were a total of 2986 episodes, initiated by 1928 individuals. Logistic regression demonstrated that when controlling for predisposing characteristics and enabling resources, the likelihood of inpatient admission did not change after initiation of the program. Moreover, there was not a significant change in the number of emergency visits. The assessment of recidivism demonstrated that only psychotic disorders (a predisposing characteristic) were a significant predictor of 30-day repeat visits. Multiple regression models examining the impact of the carve-out on length of stay demonstrated a significant increase in the emergency department length of stay (F = 5.47, p = .05) following the implementation of the carve-out. While benefits associated with improved coordination of services might be expected with the implementation of the carve-out, there was not a change in inpatient admissions, number of emergency visits, or recidivism. Additionally, there was a significant increase in the amount of time required to assess patients and to provide an appropriate disposition. The limited study sample and data prohibit generalizability. Considering that evaluations of mental health carve-outs are limited, this study reflects that anticipated benefits have not been experienced in emergency departments.
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Early Stage Investigators: Emerging Research Supporting Health EquityEcheverria, Sandra; Onukwugha, Eberechukwu (International Society on Hypertension in Blacks, 2020-09-01)
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Costs, outcomes and estimation of the cost-effectiveness of abciximab in the prevention of ischemic events over six months of follow-upReed, Shelby Ogilvie; Mullins, C. Daniel (1998)Abciximab is an antiplatelet inhibitor used in conjunction with percutaneous revascularization procedures to decrease the risk of ischemic complications such as death, nonfatal MI or subsequent revascularization procedures like angioplasty or CABG. Although the efficacy of abciximab is rarely disputed based on evidence from three large clinical trials, the cost-effectiveness of the drug when used during routine practice has been questioned since it costs approximately $1,350 per patient treated. This study was undertaken to estimate the effectiveness of abciximab in patients treated at University of Maryland Medical System (UMMS) and to estimate the incremental cost-effectiveness ratio (ICER) defined as the cost per event avoided. The composite endpoint consisted of death, MI or subsequent revascularization procedure over 6-months of follow-up. Proportional hazards regression revealed that abciximab was associated with a lower risk of ischemic events among patients with more severe angiographic morphology. Patients who received a shortened infusion of the drug (<10 hours) were at a greater risk of experiencing an event than those who received an infusion for 10-14 hours. Also, patients who underwent coronary stenting were less likely to have an event while patients with multivessel disease or a history of a percutaneous revascularization procedure were at a higher risk of experiencing an event. The cost-effectiveness analysis was performed for a subgroup of patients with more severe coronary morphology using a matched cohort design. The point estimate of the ICER revealed that it cost about $20,680 to prevent an ischemic event over six months in high-risk patients treated with abciximab. Confidence intervals for the ICER were computed using Taylor series approximation, Fieller's theorem and bootstrapping, and were graphically represented with ellipses of equal probability. Overall, the data were consistent with a wide range of plausible estimates due to a relatively small denominator in the ICER.