This application seeks a career development award for training in pharmaceutical institutions and policies, psychiatric clinical decision-making and psychopharmacology in order to inform economic research on psychotropic medications. The award period includes 3 research aims to characterize the diffusion of new psychotropic medications across a range of insurance settings, both managed and non-managed care, nationally and in several local markets in an effort to understand the inhibitors and promoters of the adoption and diffusion rate of new pharmaceutical technologies. The specific research aims of this application are 1) to describe major aggregate patterns of diffusion of principal new drugs for the treatment of behavioral health disorders, 2) to determine whether market characteristics and characteristics of psychotropic drug products and their competitors influence the diffusion of drugs at the market (aggregate) level, and 3) to develop and test behavioral models of drug diffusion at the individual level. The training and research activities will enable the candidate to synthesize current research and institutional knowledge from the pharmaceutical industry, pharmaceutical promotion efforts, and clinical literature with a theoretical framework from the discipline of economics in order to begin an important line of inquiry largely missing from the current mental health services research literature. Four mentors with expertise in areas critical to this project have been selected. Dr. Dale Christensen, professor and chair of the Dept. of Pharmaceutical Policy and Evaluative Sciences at UNC will serve as the primary mentor, providing guidance on pharmaceutical policy and marketing. Dr. Ernst Berndt, Professor of Economics at MIT, Dr. Richard Frank, Professor at Harvard and Dr. Marvin Swartz, professor of Psychiatry and Behavioral Sciences at Duke will serve as additional research advisors. The diffusion of new behavioral health technologies has been very uneven. Some psychotropic medications have diffused very quickly while others have not had much success developing a substantial market share. In order to advance models of best practice, it is important to understand the factors that underlie these varying rates of diffusion. Training in the area of pharmaceutical policy and the relevant clinical context will allow the investigator to develop a long-term research plan to study the factors that encourage or impede access to important new technologies.
| Domino, Marisa Elena; Beadles, Christopher Alan (2014) State Investments in Psychiatric Innovation: Investigating Unmeasured State Factors. Health Serv Outcomes Res Methodol 14:34-53 |
| Domino, Marisa E (2012) Does managed care affect the diffusion of psychotropic medications? Health Econ 21:428-43 |
| Domino, Marisa Elena; Martin, Bradley C; Wiley-Exley, Elizabeth et al. (2011) Increasing time costs and copayments for prescription drugs: an analysis of policy changes in a complex environment. Health Serv Res 46:900-19 |
| Sleath, Betsy; Domino, Marisa E; Wiley-Exley, Elizabeth et al. (2010) Antidepressant and antipsychotic use and adherence among Medicaid youths: differences by race. Community Ment Health J 46:265-72 |
| Domino, Marisa Elena; Burns, Barbara J; Mario, Jeremy et al. (2009) Service use and costs of care for depressed adolescents: who uses and who pays? J Clin Child Adolesc Psychol 38:826-36 |
| Wiley-Exley, Elizabeth; Domino, Marisa Elena; Maxwell, James et al. (2009) Cost-effectiveness of integrated care for elderly depressed patients in the PRISM-E study. J Ment Health Policy Econ 12:205-13 |
| Huskamp, Haiden A; Busch, Alisa B; Domino, Marisa E et al. (2009) Antidepressant reformulations: who uses them, and what are the benefits? Health Aff (Millwood) 28:734-45 |
| Horvitz-Lennon, Marcela; Donohue, Julie M; Domino, Marisa E et al. (2009) Improving quality and diffusing best practices: the case of schizophrenia. Health Aff (Millwood) 28:701-12 |
| Domino, Marisa Elena; Foster, E Michael; Vitiello, Benedetto et al. (2009) Relative cost-effectiveness of treatments for adolescent depression: 36-week results from the TADS randomized trial. J Am Acad Child Adolesc Psychiatry 48:711-20 |
| Domino, Marisa Elena; Swartz, Marvin S (2008) Who are the new users of antipsychotic medications? Psychiatr Serv 59:507-14 |
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