June Issue of JMCP Features Articles on Cardiovascular Disease, Adherence, End-Stage Renal Disease

Alexandria, Va., May 26, 2015 — The Academy of Managed Care Pharmacy has published the June issue of the Journal of Managed Care & Specialty Pharmacy (JMCP). The issue includes articles on resource costs associated with nonfatal major adverse cardiovascular events; adherence barriers among patients with cardiovascular risk factors; and compliance among U.S. patients receiving pazopanib or sunitinib as first-line therapy for advanced renal cell carcinoma.

Below are summaries of each article. To read the June 2015 issue of JMCP, visit www.amcp.org/jmcp.

Article: Health Care Resource Utilization and Costs Associated with Nonfatal Major Adverse Cardiovascular Events

BACKGROUND: Risk of recurrent cardiovascular events following an initial cardiovascular-related hospitalization remains high despite available interventions. Rates of cardiovascular events as well as associated health care resource utilization and costs are needed to assess the value of treatments.

OBJECTIVE: To quantify, in patients with previous hospitalization for acute coronary syndrome (ACS), rates of nonfatal major adverse cardiovascular events (MACE) and secondary coronary events (SCE), as well as health care utilization and costs associated with a first MACE.

CONCLUSIONS: MACEs and SCEs represent a common and costly burden in the year following ACS hospitalization. Our findings may inform future economic assessments of new therapies aimed at prevention of MACEs and SCEs.

Article: The Effect of a Diabetes Collaborative Care Management Program on Clinical and Economic Outcomes in Patients with Type 2 Diabetes

BACKGROUND: Clinical pharmacy services (CPS) in the primary care setting have been shown to help patients attain treatment goals and improve outcomes. However, the availability of CPS in community-based primary care is not widespread. One reason is that current fee-for-service models offer limited reimbursement opportunities for CPS in the community setting. Furthermore, data demonstrating the value of CPS in this setting are limited, making it difficult for providers to determine the feasibility and sustainability of incorporating CPS into primary care practice.

OBJECTIVES: To (a) evaluate the association between a pharmacist-led, diabetes collaborative drug therapy management program and patient outcomes, including glycemic control and health care costs, and (b) assess short-term economic outcomes in a primary care setting.

CONCLUSIONS: A pharmacist-led diabetes collaborative care management program in a patient-centered primary care setting was associated with significantly better follow-up glycemic control relative to comparison patients. Further, the data suggest that the DCCM program was associated with a less substantial increase in all-cause total costs in patients with uncontrolled T2DM relative to comparison patients, which could translate into reduced costs and improved outcomes to managed care payers.

Article: Clinical Outcomes and Medication Adherence in Acute Coronary Syndrome Patients With and Without Type 2 Diabetes Mellitus: A Longitudinal Analysis 2006-2011

BACKGROUND: The presence of type 2 diabetes mellitus magnifies the risks associated with acute coronary syndrome (ACS), increasing the risk of recurrent cardiovascular events (CVEs) and doubling the risk of death. Managing cardiovascular risk factors has little effect on lowering the mortality risk in patients with type 2 diabetes.

OBJECTIVE: To evaluate the relationship between type 2 diabetes mellitus and subsequent CVEs and medication adherence following ACS hospitalization.

CONCLUSIONS: This analysis demonstrates that patients with type 2 diabetes have a higher risk of subsequent CVEs following an initial event versus those without diabetes, despite evidence of higher treatment persistence for certain medications. Adherence rates remained suboptimal, suggesting a continuing need for patient education.

Article: Patient-Reported Medication Adherence Barriers Among Patients with Cardiovascular Risk Factors

BACKGROUND: Many patients experience barriers that make it difficult to take cardiovascular disease (CVD)-related medications as prescribed. The Cardiovascular Intervention Improvement Telemedicine Study (CITIES) was a tailored behavioral pharmacist-administered and telephone-based intervention for reducing CVD risk.

OBJECTIVES: To (a) describe patient-reported barriers to taking their medication as prescribed and (b) evaluate patient-level characteristics associated with reporting medication barriers.

CONCLUSIONS: Barriers to medication adherence are common. Evaluating and addressing barriers may increase medication adherence.

Article: Predictors of Concomitant Use of Antipsychotics and Stimulants and Its Impact on Stimulant Persistence in Pediatric Attention Deficit Hyperactivity Disorder

BACKGROUND: Concomitant use of stimulants and atypical antipsychotics is common in pediatric attention deficit hyperactivity disorder (ADHD). However, little is known about the determinants of concomitant use and its utility in the management of pediatric ADHD.

OBJECTIVES: To (a) examine predictors of concomitant stimulant and atypical antipsychotic use and (b) evaluate the impact of concomitant atypical antipsychotic use on the persistence of stimulants in children and adolescents diagnosed with ADHD.

CONCLUSIONS: Various predisposing, enabling, and need factors were associated with the concomitant stimulant and atypical antipsychotic use. Concomitant use of atypical antipsychotics was associated with improved LAS treatment persistence in children and adolescents with ADHD.

Article: Association Between Gastrointestinal Events and Persistence with Osteoporosis Therapy: Analysis of Administrative Claims of a U.S. Managed Care Population

BACKGROUND: A large proportion of patients do not persist with osteoporosis (OP) therapy. Gastrointestinal (GI) events (e.g., gastroesophageal reflux disease and nausea/vomiting) are common among OP patients receiving OP therapy and may impact persistence with treatment.

Objective: To examine the association of GI events and persistence with OP therapy.

CONCLUSIONS: Among women aged 55 years or older in a U.S. managed care population, post-treatment GI events were associated with a higher risk of discontinuation of oral BIS or switching to non-BIS.

Article: Article: Managing Oral Phosphate Binder Medication Expenditures Within the Medicare Bundled End-Stage Renal Disease Prospective Payment System: Economic Implications for Large U.S. Dialysis Organizations

BACKGROUND: From January 2016, payment for oral-only renal medications (including phosphate binders and cinacalcet) was expected to be included in the new Medicare bundled end-stage renal disease (ESRD) prospective payment system (PPS). The implementation of the ESRD PPS has generated concern within the nephrology community because of the potential for inadequate funding and the impact on patient quality of care.

OBJECTIVE: To estimate the potential economic impact of the new Medicare bundled ESRD PPS reimbursement from the perspective of a large dialysis organization in the United States.

CONCLUSIONS: Our findings suggest that large dialysis organizations will be challenged to manage phosphate binder expenditures within the planned Medicare bundled rate structure. As a result, large dialysis organizations may have to make treatment choices in light of potential inadequate funding, which could have important implications for the quality of care for patients with ESRD.

Article: Persistence and Compliance Among U.S. Patients Receiving Pazopanib or Sunitinib as First-Line Therapy for Advanced Renal Cell Carcinoma: A Retrospective Claims Analysis

BACKGROUND: For first-line therapy options for advanced renal cell carcinoma (RCC), clinical trials have demonstrated similar efficacy for pazopanib and sunitinib as well as differing side-effect profiles, which may affect patient persistence in self-administration of these oral medications. However, the treatment patterns of each drug in real-world clinical practice, as opposed to the controlled environment of a trial, have not been directly compared.

OBJECTIVE: To compare persistence and compliance (adherence) with pazopanib versus sunitinib in a real-world setting.

CONCLUSIONS: In the first 6 months of treatment, persistence and compliance to pazopanib and sunitinib were similar. Future studies are needed, including those assessing larger cohorts and longer follow-up periods.

About JMCP
The Journal of Managed Care & Specialty Pharmacy (JMCP) publishes peer-reviewed original research manuscripts, subject reviews, and other content intended to advance the use of the scientific method, including the interpretation of research findings in managed care pharmacy. JMCP is dedicated to improving the quality of care delivered to patients served by managed care pharmacy by providing its readers with the results of scientific investigation and evaluation of clinical, health, service, and economic outcomes of pharmacy services and pharmaceutical interventions, including formulary management. JMCP strives to engage and serve professionals in pharmacy, medicine, nursing, and related fields to optimize the value of pharmaceutical products and pharmacy services delivered to patients. JMCP employs extensive bias-management procedures that include (a) full disclosure of all sources of potential bias and conflicts of interest, nonfinancial as well as financial; (b) full disclosure of potential conflicts of interest by reviewers as well as authors; and (c) accurate attribution of each author's contribution to the article. Aggressive bias-management methods are necessary to ensure the integrity and reliability of published work.