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Secular Trends in the Cost of Immunosuppressants after Solid Organ Transplantation in the United States.

ABSTRACT: BACKGROUND AND OBJECTIVES:Immunosuppressive medications are critical for maintenance of graft function in transplant recipients but can represent a substantial financial burden to patients and their insurance carriers. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:To determine whether availability of generic immunosuppressive medications starting in 2009 may have alleviated some of that burden, we used Medicare Part D prescription drug events between 2008 and 2013 to estimate the average annualized per-patient payments made by patients and Medicare in a large national sample of kidney, liver, and heart transplant recipients. Repeated measures linear regression was used to determine changes in payments over the study period. RESULTS:Medicare Part D payments for two commonly used immunosuppressive medications, tacrolimus and mycophenolic acid (including mycophenolate mofetil and mycophenolate sodium), decreased overall by 48%-67% across organs and drugs from 2008 to 2013, reflecting decreasing payments for brand and generic tacrolimus (21%-54%), and generic mycophenolate (72%-74%). Low-income subsidy payments, which are additional payments made under Medicare Part D, also decreased during the study period. Out-of-pocket payments by patients who did not receive the low-income subsidy decreased by more than those who did receive the low-income subsidy (63%-79% versus 24%-44%). CONCLUSIONS:The decline in payments by Medicare Part D and by transplant recipients for tacrolimus and mycophenolate between 2008 and 2013 suggests that the introduction of generic immunosuppressants during this period has resulted in substantial cost savings to Medicare and to patients, largely reflecting the transition from brand to generic products.

SUBMITTER: Helmuth ME

PROVIDER: S-EPMC6419280 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Secular Trends in the Cost of Immunosuppressants after Solid Organ Transplantation in the United States.

Helmuth Margaret E ME Liu Qian Q Turenne Marc N MN Park Jeong M JM Oguntimein Murewa M Dutcher Sarah K SK Balkrishnan Rajesh R Sharma Pratima P Zee Jarcy J Leichtman Alan B AB Smith Abigail R AR

Clinical journal of the American Society of Nephrology : CJASN 20190228 3

<h4>Background and objectives</h4>Immunosuppressive medications are critical for maintenance of graft function in transplant recipients but can represent a substantial financial burden to patients and their insurance carriers.<h4>Design, setting, participants, & measurements</h4>To determine whether availability of generic immunosuppressive medications starting in 2009 may have alleviated some of that burden, we used Medicare Part D prescription drug events between 2008 and 2013 to estimate the ...[more]

PMID: 30819667

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Project description:BackgroundDeath rates for the four major cancer sites (lung, breast, prostate, and colon and rectum) have declined steadily in the United States among persons aged 25-64 years since the early 1990s. We used national data to examine these trends in relation to educational attainment.MethodsWe calculated age-standardized death rates for each of the four cancers by level of education among 25- to 64-year-old non-Hispanic white and non-Hispanic black men and women for 1993 through 2001 using data on approximately 86% of US deaths from the National Center for Health Statistics, education level as recorded on the death certificate, and population data from the US Bureau of Census Current Population Survey. Annual percent changes in age-adjusted death rates were estimated using weighted log-linear regression models. All statistical tests were two-sided.ResultsDeath rates for each cancer decreased statistically significantly from 1993 to 2001 in people with at least 16 years of education in every sex and race stratum except lung cancer in black women, for whom death rates were stable. For example, colorectal cancer death rates among white men, black men, white women, and black women with at least 16 years of education decreased by 2.4% (P < .001), 4.8% (P = .011), 3.0% (P < .001), and 2.6% (P = .030) annually, respectively. By contrast, among people with less than 12 years of education, a statistically significant decrease in death rates from 1993 through 2001 was seen only for breast cancer in white women (1.4% per year; P = .029). Death rates among persons with less than 12 years of education over the same time interval increased for lung cancer in white women (2.4% per year; P < .001) and for colon cancer in black men (2.7% per year; P < .001) and were stable for the remaining race/sex/site strata. Temporal trends generally followed an educational gradient in which the slopes of the decreases in death rate became steeper with higher educational attainment.ConclusionThe recent declines in death rates from major cancers in the United States mainly reflect declines in more highly educated individuals.

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Secular Trends in the Cost of Immunosuppressants after Solid Organ Transplantation in the United States.

Publications

Secular Trends in the Cost of Immunosuppressants after Solid Organ Transplantation in the United States.

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