Abstract:
AIM:Prescription drug prices in the United States are considered rather extreme. Americans spend over $460 billion on drugs annually, or almost 17 percent of total national healthcare spending. How innovation incentives and insurance coverage drive pricing, diffusion, and utilization of drugs, under conditions of risk and competition, are multi-dimensional issues in medical economics that remain under-explored in the current empirical literature. We seek to address these issues in reviewing relevant studies presented at the 2020 AEA-ASSA annual convention. APPROACH:Drawn from the 2020 convention panel sessions devoted to health economics, empirical evidence was thematically analyzed for charted new research terrains and trajectories. Their theoretical and practical implications on efficiency, effectiveness, and value in drug production and consumption were then identified. FINDINGS:With certain qualifications, evidence confirms price inelasticity of prescription drugs and medical treatments, along with substitution effects from high or continuously rising prices. While health insurance induces ex ante moral hazard, albeit on a larger scale than previously considered, losing dependent coverage can incentivize price-substitution to risky and illegal drugs, including those sold on the black market. At the firm level, drug patenting and exclusivity rights suggest that innovation incentives increase new or novel clinical trials and generic utilization to a considerable extent. But innovation can produce strong, offsetting effects. It can distort competition and cause (at times sharp) price increases from product-hopping, (compensatory) list pricing, industry mergers and acquisitions, and capture of positive spillovers by competitors, rather than by focal developers, in follow-on innovations. In fine, there remains room for opportunism among firms, particularly market incumbents, and many loopholes are unplugged by U.S. healthcare reform. These make drug utilization costly to the insured, and risky to those who are - or become - uninsured or underinsured for various reasons. CONCLUSIONS:The fundamental disconnect between innovation cost and drug pricing demands public attention and policy intervention, which have proved largely elusive to date. Gaming the system in the name of scientific invention and discovery to reap additional benefits, at the expense of consumer health and income, brings to question the offsetting benefits of firm innovation. It also raises separate issues of fairness and equity. Innovation needs to be considered from the perspective of value lines and beyond conventional marketing incentives to drug utilization, with or without insurance coverage. Cost-effectiveness and cost-benefit analyses figure prominently under a value-based system of resource allocation, insurance, medical prescription, purchasing, and reimbursement.
journal_name
J Med Econjournal_title
Journal of medical economicsauthors
Mendoza RLdoi
10.1080/13696998.2020.1772797subject
Has Abstractpub_date
2020-09-01 00:00:00pages
915-922issue
9eissn
1369-6998issn
1941-837Xjournal_volume
23pub_type
杂志文章abstract:OBJECTIVE:This study evaluated infection-related hospitalization risk and cost in tumor necrosis factor inhibitor (TNFi)-experienced and targeted DMARD (tDMARD) naïve rheumatoid arthritis (RA) patients that were treated with abatacept, TNFi, or other non-TNFi. METHODS:This retrospective study used 100% Medicare Fee-fo...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2021.1881525
更新日期:2021-01-27 00:00:00
abstract:OBJECTIVE:Duloxetine is indicated for treatment of major depressive disorders in the UK. While clinical trials have documented its clinical effectiveness, little is known regarding the relationship between duloxetine use and healthcare utilization in community practice. This study quantifies the impact of treatment wit...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696998.2012.672941
更新日期:2012-01-01 00:00:00
abstract:OBJECTIVE:This study compared real-world treatment patterns and healthcare costs among biologic-naive psoriasis patients initiating apremilast or biologics. METHODS:A retrospective cohort study was conducted using the Optum Clinformatics™ claims database. Patients with psoriasis were selected if they had initiated apr...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2019.1571500
更新日期:2019-04-01 00:00:00
abstract::Background: Procedural efficiencies can contribute to cost reductions in transcatheter aortic valve replacement procedures (TAVR). The objective of this study is to determine operating room (OR) variable cost per minute in endovascular TAVR procedures, in a real-world hospital setting. Methods: Using Premier data from...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2019.1627364
更新日期:2019-10-01 00:00:00
abstract:OBJECTIVE:To quantify the health economic impact of managing cow milk allergy (CMA) in South Africa, from the perspective of healthcare insurers in both the private and public sectors and parents/carers of CMA sufferers. METHODS:A decision model depicting the management of CMA in South Africa was constructed, using in...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696998.2010.482904
更新日期:2010-01-01 00:00:00
abstract:OBJECTIVE:Reduction in health-related quality of life is common in children born small for gestational age (SGA) or children with growth hormone deficiency (GHD). Growth hormone treatment with somatropin in these children leads to normalisation of height. The aim of this study was to determine whether somatropin is a c...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696991003652248
更新日期:2010-03-01 00:00:00
abstract:OBJECTIVES:This retrospective study aims to examine the association between prescribing information (PI)-concordant oral antidiabetic drug (OAD) treatment and clinical and economic outcomes in patients with type 2 diabetes mellitus and stages 3-5 chronic kidney disease (CKD). METHODS:The study used a large, national a...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696998.2013.775135
更新日期:2013-01-01 00:00:00
abstract:OBJECTIVE:To describe costs, healthcare resource utilization, and adherence of US patients receiving human regular U-500 insulin (U-500R), compared to patients receiving high-dose (>200 units/day) U-100 insulins (U-100) by subcutaneous injection for the treatment of diabetes. METHODS:A retrospective analysis of data f...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696998.2013.772059
更新日期:2013-01-01 00:00:00
abstract:AIMS:Six Delta is a six-dimensional independent platform for outcome-based pricing/contracting. The six dimensions have been described separately: (δ1) cost-effectiveness analysis and cost-utility analysis-based pricing; (δ2) willingness-to-pay-based pricing; (δ3) reference-based pricing; (δ4) safety-based pricing; (δ5...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2020.1815031
更新日期:2020-11-01 00:00:00
abstract:BACKGROUND:Efficient use of government funding has been increasingly relevant for the success and sustainability of ongoing health-system reform in China; however, as there is no generic substitution policy, patients and basic health-insurance programs pay more for public-preferred brand originators. Such phenomenon is...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2016.1181641
更新日期:2016-09-01 00:00:00
abstract:INTRODUCTION:Triple therapy using a protease inhibitor (PI) with peginterferon and ribavirin (PR) is increasingly used in patients with chronic hepatitis C virus (HCV) infection. The most recently introduced PI, simeprevir (SMV), offers high levels of viral eradication combined with a reduced overall duration of therap...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696998.2015.1044457
更新日期:2015-01-01 00:00:00
abstract::Background: IVF is now a wide spread procedure globally, and currently 65 countries report annually all or part of their IVF/ICSI cycles, from which the International Committee Monitoring progress in Assisted Reproduction Technology (ICMART) published its report. There is considerable variation in the utilization (num...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2019.1609484
更新日期:2019-09-01 00:00:00
abstract:OBJECTIVE:To evaluate total annual all-cause, gastrointestinal-related, and symptom-related healthcare costs among chronic constipation (CC) patients and estimate incremental all-cause healthcare costs of CC patients relative to matched controls. METHODS:Patients aged ≥18 years with continuous medical and pharmacy ben...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696998.2013.860375
更新日期:2014-02-01 00:00:00
abstract::Aims: To evaluate total costs and health consequences of a colorectal cancer (CRC) screening program with colonoscopy, fecal immunochemical tests (FIT), and expanded use of multitarget stool DNA (mt-sDNA) from the perspectives of Integrated Delivery Networks (IDNs) and payers in the United States.Materials and methods...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2020.1730123
更新日期:2020-06-01 00:00:00
abstract:AIM:Renal failure is a growing public health problem, and is mainly treated by hemodialysis. This study aims to estimate the societal costs of hemodialysis in Lebanon. METHODS:This was a quantitative, cross-sectional cost-of-illness study conducted alongside the Nutrition Education for Management of Osteodystrophy tri...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2016.1207653
更新日期:2016-12-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to determine the cost effectiveness (from a payer's perspective) of adding clostridial collagenase ointment (CCO) to selective debridement compared with selective debridement alone (non-CCO) in the treatment of stage IV pressure ulcers among patients identified from the US Wound ...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2016.1252381
更新日期:2017-03-01 00:00:00
abstract:AIMS:Fast-acting insulin analogues (FAIAs) reduce hypoglycaemia and improve administration flexibility compared with short-acting human insulin (SHI). This analysis examines whether these benefits translate into cost offsets when comparing the total treatment costs for FAIA versus SHI used as basal-bolus therapy for tr...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696998.2011.588892
更新日期:2011-01-01 00:00:00
abstract:OBJECTIVE:Iso-osmolar Iodixanol is associated with a lower rate of contrast-induced acute kidney injury (CI-AKI) in patients at increased risk compared to low-osmolar contrast media (LOCM). The aim of this study was to assess the financial consequences of CI-AKI risk reduction in patients undergoing coronary angiograph...
journal_title:Journal of medical economics
pub_type: 杂志文章,meta分析,评审
doi:10.3111/13696998.2015.1105809
更新日期:2016-01-01 00:00:00
abstract:OBJECTIVE:Two human papillomavirus (HPV) vaccines are on the market. Based on expected differences in sustained- and cross-protection between the two vaccines, their long-term economic value is modelled and compared for France, Ireland and Italy. METHODS:A Markov cohort model reproducing the natural history of HPV inf...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696998.2010.490481
更新日期:2010-01-01 00:00:00
abstract:OBJECTIVE:To compare all-cause and diabetes-related resource utilization and healthcare charges among adults with type 2 diabetes mellitus who initiated therapy with mealtime insulin disposable pens or vials. METHODS:Data were obtained from the Innovus inVision database from January 1, 2006 through June 30, 2010. Gene...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696998.2013.823091
更新日期:2013-10-01 00:00:00
abstract:PURPOSE:To evaluate the insulin wastage and associated acquisition costs when switching from individual patient supply (IPS) of 3-mL pens of rapid-acting insulin (RAI) aspart to floor stock (FS) dispensing of 3-mL vials of RAI lispro, and with conversion from IPS of 3-mL pens to centralized unit dose (CUD) of 10-mL via...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2017.1288126
更新日期:2017-05-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to describe the economic burden to managed care associated with failure of selective serotonin reuptake inhibitor (SSRI) therapy in terms of direct medical costs. METHODS:A retrospective analysis of the PharMetrics database, a national managed care medical and pharmacy claims ...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696990802522339
更新日期:2008-01-01 00:00:00
abstract:OBJECTIVE:The Affordable Care Act (ACA) established the Hospital-Acquired Condition (HAC) Reduction Program. The Centers for Medicare and Medicaid Services (CMS) established a total HAC scoring methodology to rank hospitals based upon their HAC performance. Hospitals that rank in the lowest quartile based on their HAC ...
journal_title:Journal of medical economics
pub_type: 杂志文章,评审
doi:10.1080/13696998.2017.1396993
更新日期:2018-01-01 00:00:00
abstract:OBJECTIVES:The purpose of this study is to report on long-term treatment patterns in a back pain population and to consider whether these may be considered as reflective of under-treatment of pain or poor pain control. METHODS:Data are from a commissioned recontact SELECT survey of persons who had previously reported ...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696998.2013.777346
更新日期:2013-01-01 00:00:00
abstract::Background: The potential impact of disease management to optimize quality of care, health outcomes, and total healthcare costs across a range of cardiac disease states is unknown. Methods: A trial-based cost-utility analysis was conducted alongside a randomized controlled trial of 335 patients with chronic, non-valvu...
journal_title:Journal of medical economics
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1080/13696998.2019.1631831
更新日期:2019-09-01 00:00:00
abstract:BACKGROUND:A Phase-3 study of defibrotide compared with historical controls demonstrated a 23% improvement in 100-day survival post-hematopoietic stem cell transplantation (HSCT) among patients with veno-occlusive disease with multi-organ dysfunction (VOD with MOD). AIM:To estimate the budget impact and cost-effective...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2016.1275652
更新日期:2017-05-01 00:00:00
abstract:BACKGROUND:Patients with unresectable, metastatic colorectal cancer with wild type Kirsten ras mutational status are eligible for sequential treatments which include monoclonal antibodies as first line (1L), second line (2L), or third line (3L) regimens. OBJECTIVE:To compare the economic outcomes of different sequence...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696998.2013.864973
更新日期:2014-02-01 00:00:00
abstract:BACKGROUND:Currently the majority of cancer deaths occur in low- and middle-income countries, where there are appreciable funding concerns. In Kenya, most patients currently pay out of pocket for treatment, and those who are insured are generally not covered for the full costs of treatment. This places a considerable b...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2018.1484372
更新日期:2018-09-01 00:00:00
abstract:OBJECTIVE:The objective of the current study was to propose an alternative method for measuring individual operator and peer volumes to use as predictors for adverse outcomes. STUDY DESIGN:A retrospective analysis was performed to assess the volume-outcome relationship for percutaneous coronary intervention (PCI) perf...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696990701815578
更新日期:2008-01-01 00:00:00
abstract:BACKGROUND:Biologic treatments have enhanced the treatment outcomes of patients with active ankylosing spondylitis (AS). Until recently, TNF-alpha-inhibitors have been the only biologics approved for the treatment of active AS. The objective of this study was to assess the potential financial impact of the first non-TN...
journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2018.1551227
更新日期:2019-02-01 00:00:00