Policies to contain prescription drug costs in the elderly are widely debated because they will impact heavily on the health of older Americans as well as affect the fundability of federal and statewide programs of drug coverage for the elderly. Many coverage plans include annual deductibles that require the patient to pay 100% of drug costs out-of-pocket until a predefined deductible limit is reached. Income-based deductibles set these limits to vary directly with the patient's income status. Although we have shown earlier that some drug cost containment methods can result in net health care savings without adverse outcomes in an elderly population (R01-HS10881), it remains unclear to what extent income-based deductibles may adversely affect adherence to chronic drug therapy and health outcomes in elderly and poor patients. Based on our earlier work we propose to study the clinical and economic consequences of an income-based deductible policy in a large-scale natural experiment in the province of British Columbia. Starting January 2003, all residents 65+ (about 500,000) will be subjected to such a policy. We will use longitudinal data analysis for linked individual-level health care data describing medication use, other health care use, and clinical events in all such patients. Additional analyses will implement patients' self-report in a subgroup of patients. We will focus on specific drug classes and chronic conditions that are prevalent in elderly patients in which a dose reduction or discontinuation would be most important, or likely cause measurable adverse health effects. The project will produce the first data describing the clinical and economic consequences of such a cost-containment policy in a large and stable population of older patients. It will also analyze savings for drug benefit plans and the impact of financial contributions by patients. Its findings will be of great importance for the ongoing debate over proposed programs for drug coverage in the elderly and will provide a set of refined recommendations and tools for planning, implementing, and executing future policies. A separate dissemination component will bring together researchers and policymakers from a variety of settings to review these findings and assess their relevance to emerging research and policy issues related to drug therapy for the elderly.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG021950-03
Application #
6930511
Study Section
Special Emphasis Panel (ZRG1-SNEM-4 (01))
Program Officer
Haaga, John G
Project Start
2003-09-01
Project End
2007-05-31
Budget Start
2005-09-01
Budget End
2006-08-31
Support Year
3
Fiscal Year
2005
Total Cost
$311,400
Indirect Cost
Name
Brigham and Women's Hospital
Department
Type
DUNS #
030811269
City
Boston
State
MA
Country
United States
Zip Code
02115
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Schneeweiss, Sebastian; Setoguchi, Soko; Brookhart, M Alan et al. (2009) Assessing residual confounding of the association between antipsychotic medications and risk of death using survey data. CNS Drugs 23:171-80
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Schneeweiss, Sebastian; Rassen, Jeremy A; Glynn, Robert J et al. (2009) High-dimensional propensity score adjustment in studies of treatment effects using health care claims data. Epidemiology 20:512-22
Rassen, Jeremy A; Brookhart, M Alan; Glynn, Robert J et al. (2009) Instrumental variables I: instrumental variables exploit natural variation in nonexperimental data to estimate causal relationships. J Clin Epidemiol 62:1226-32
Dormuth, Colin R; Maclure, Malcolm; Glynn, Robert J et al. (2008) Emergency hospital admissions after income-based deductibles and prescription copayments in older users of inhaled medications. Clin Ther 30 Spec No:1038-50
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Polinski, Jennifer M; Maclure, Malcolm; Marshall, Blair et al. (2008) Does knowledge of medication prices predict physicians'support for cost effective prescribing policies. Can J Clin Pharmacol 15:e286-94
Schneeweiss, Sebastian (2007) Reference drug programs: effectiveness and policy implications. Health Policy 81:17-28

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