Analysis of State-Level Drug Pricing Transparency Laws in the United States.
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ABSTRACT:
SUBMITTER: Ryan MS
PROVIDER: S-EPMC6763978 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Background:In recent years, the price of many older generic drugs, including numerous antibiotics, has increased substantially. We sought to analyze recent price changes and extent of generic competition within a cohort of commonly prescribed off-patent oral antibiotics. Methods:We extracted oral antibiotics recommended for common outpatient conditions in the Infectious Diseases Society of America Practice Guidelines. We determined all US Food and Drug Administration-approved manufacturers for each formulation and strength in 2013 and 2016 and the yearly national average drug acquisition cost (NADAC) price between 2013 and 2016. Wilcoxon signed rank test was used to compare changes in drug prices and number of manufacturers from 2013 to 2016. Spearman correlation coefficient was used to assess the association between drug prices and number of manufacturers. Results:Twenty-two antibiotics (81 formulations and strengths) were analyzed. There was no change in the median NADAC price or the number of manufacturers between 2013 and 2016. However, 11 (14%) formulations increased in price by 90% or more, and 13 (16%) had 2 or fewer manufacturers during all 4 years. Antibiotic prices were negatively associated with the number of available manufacturers. Conclusions:While prices and the number of manufacturers for common oral antibiotics were overall stable between 2013 and 2016, reduced manufacturer competition was associated with increased prices. A subset of antibiotics exhibited substantial price increases, and most, but not all, had limited manufacturer competition. Policy solutions are needed to ensure availability of low-cost, essential generic antibiotics.
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Project description:BackgroundPrescription opioid misuse is an ongoing crisis and a risk factor for injection drug use (IDU). Few studies have evaluated strategies for preventing opioid or IDU initiation among adolescents. We evaluated changes in the proportion of adolescents reporting IDU before and after prescription drug monitoring program (PDMP) mandates were implemented in 18 states compared to 29 states without such mandates.Methods and findingsThis difference-in-differences analysis used biannual Youth Risk Behavioral Surveillance System (YRBSS) data representative of adolescents 17 to 18 years old across 47 states from 1995 to 2017. We compared changes in adolescent IDU in 18 states with and 29 states without PDMP mandates. Among 331,025 adolescents, 51.7% identified as male, 62.1% as non-Hispanic white, 17.4% as non-Hispanic black, and 14.6% as Hispanic. Overall, 3.5% reported IDU during the 2 years prior to PDMP mandates. In the final multivariable difference-in-differences model, we included individual age, sex, and race/ethnicity, as well as state and year as covariates from the YRBSS. We also included state- and year-specific poverty rates based on US Census Bureau data. Additionally, we controlled for state implementation of (non-mandated) PDMPs before states subsequently implemented mandates and pill mill laws. We conducted several sensitivity analyses, including repeating our main analysis using a logistic, rather than linear, model, and with a lead indicator on PDMP mandate implementation, a lag indicator, and alternative policy implementation dates. PDMP mandates were associated with a 1.5 percentage point reduction (95% CI -2.3 to -0.6 percentage points; p = 0.001) in adolescent IDU, on average over the years following mandate implementation, a relative reduction of 42.9% (95% CI -65.7% to -17.1%). The association of PDMP mandates with this reduction persisted at least 4 years beyond implementation. Sensitivity analyses were consistent with the main results. Limitations include the multi-stepped causal pathway from PDMP mandate implementation to changes in IDU and the potential for omitted state-level time-varying confounders.ConclusionsOur analysis indicated that PDMP mandates were associated with a reduction in adolescent IDU, providing empirical evidence that such mandates may prevent adolescents from initiating IDU. Policymakers might consider PDMP mandates as a potential strategy for preventing adolescent IDU.
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Project description:In the United States, animal contact exhibits, such as petting zoos and agricultural fairs, have been sources of zoonotic infections, including infections with Escherichia coli, Salmonella, and Cryptosporidium (1-4). The National Association of State Public Health Veterinarians recommends handwashing after contact with animals as an effective prevention measure to disease transmission at these exhibits (4). This report provides a list of states that have used law, specifically statutes and regulations, as public health interventions to increase hand sanitation at animal contact exhibits. The report is based on an assessment conducted by CDC's Public Health Law Program, in collaboration with the Division of Foodborne, Waterborne, and Environmental Diseases in CDC's National Center for Emerging and Zoonotic Infectious Diseases. The assessment found that seven states have used statutes or regulations to require hand sanitation stations at these exhibits (5). Jurisdictions seeking to improve rates of hand sanitation at animal contact exhibits can use this report as a resource in developing their own legal interventions.
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Project description:ObjectiveTo assess legislation requiring drug companies to report gifts to providers, and to evaluate the information obtained.Data sourcesData included legislation in Vermont, Minnesota, Maine, Massachusetts, West Virginia, and the District of Columbia, and company disclosure data from Vermont.Study designWe evaluated the strengths and weaknesses of state legislation. We also analyzed 4 years of company disclosures from Vermont, assessing the value and distribution of industry-provider exchanges and identifying emerging trends in companies' practices.Data collection methodsState legislation is publically available. We obtained Vermont's data through requests to the state's Attorney General's office.Principal findingsOf the state laws, only Vermont's yielded robust, publically available data. These data show gifting was dominated by a few major corporations, and <2 percent of Vermont's prescribers received 69 percent of gifts and payments. Companies were especially generous to specialists in psychiatry, endocrinology/diabetes/metabolism, internal medicine, and neurology. Companies increasingly used loopholes in the law to avoid public scrutiny.ConclusionsDisclosure laws are an important first step in bringing greater transparency to physician-industry relationships. But flaws and weaknesses limit the states' ability to render physician-industry exchanges fully transparent. Future efforts should build on these lessons to render physician-industry relationships fully transparent.
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Project description:Currently, no federal policies exist in the United States regarding private wells; this authority is devolved to states. This study inventoried state-level policies governing private wells in the United States in order to identify the topics addressed by each state, division of responsibilities across state agencies, and geographic differences in policy comprehensiveness. From May to August 2016, two independent reviewers conducted an online search followed by directly contacting state agencies (98% response) to identify all state-level policies in the United States that directly reference private wells. The search, updated in April 2018, confirmed the existing water policy list and identified 23 additional policies. Policies were then coded according to nine not-mutually-exclusive classifications. The results indicate that all states had at least one policy addressing private well drilling or construction. Significant geographic differences exist in maintenance-related policies. In conclusion, although drilling and construction safety are addressed by each state, some policy domains are addressed inconsistently across states, and other policy domains are absent in most states.
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Project description:As of 1st June 2020, the US Centres for Disease Control and Prevention reported 104,232 confirmed or probable COVID-19-related deaths in the US. This was more than twice the number of deaths reported in the next most severely impacted country. We jointly model the US epidemic at the state-level, using publicly available death data within a Bayesian hierarchical semi-mechanistic framework. For each state, we estimate the number of individuals that have been infected, the number of individuals that are currently infectious and the time-varying reproduction number (the average number of secondary infections caused by an infected person). We use changes in mobility to capture the impact that non-pharmaceutical interventions and other behaviour changes have on the rate of transmission of SARS-CoV-2. We estimate that Rt was only below one in 23 states on 1st June. We also estimate that 3.7% [3.4%-4.0%] of the total population of the US had been infected, with wide variation between states, and approximately 0.01% of the population was infectious. We demonstrate good 3 week model forecasts of deaths with low error and good coverage of our credible intervals.
| S-EPMC7712910 | biostudies-literature
Project description:Rationale: The cancer mortality-to-incidence ratio (MIR) can serve as a population-based indicator for cancer care outcomes. In the US, evaluation of lung cancer survival by individual states has not been evaluated. Objective: To assess the association between lung cancer survival by using MIRs and state-level health disparities in the United States. Methods: We calculated 5-year lung cancer MIR averages from 2011 to 2015 using the United States Cancer Statistics (USCS) data. America's Health Rankings (AHR) is a platform using weighted measures in five different categories to calculate annual state health rankings. Five-year averages from 2011 to 2015 of the health uninsured rate and 4-year averages from 2011 to 2014 of health spending per capita were obtained from the U.S. Census Bureau and Centers for Medicare & Medicaid Services. Linear regression analyses were performed to determine the associations between cancer survival value (CSV) = (1 - MIR) × 100% and state health variables. Results: During the study period, the 5-year averages of age-adjusted incidence, mortality rates, and CSVs were 60.3 ± 2.1 per 100,000 population, 43.4 ± 2.1 per 100,000, and 27.9 ± 3.9%, respectively. Among the 50 states, Connecticut had the highest CSV (38.6 ± 1.7%) whereas Nevada had the lowest CSV (18.7 ± 6.5%). Hawaii had the highest health ranking and Mississippi had the lowest ranking in 2016. States with better health rankings, lower health uninsured rates, and higher health spending were significantly associated with higher CSVs (R 2 = 0.418, P < 0.001; R 2 = 0.352, P < 0.001; R 2 = 0.142, P = 0.007, respectively). Conclusions: There are significant differences in lung cancer survival within the United States. Lung cancer survival by using CSV was strongly associated with state health disparities, and it can be an applicable measure to evaluate the state-level health disparities in the United States.
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Project description:During an epidemic, metrics such as R0, doubling time, and case fatality rates are important in understanding and predicting the course of an epidemic. However, if collected over country or regional scales, these metrics hide important smaller-scale, local dynamics. We examine how commonly used epidemiological metrics differ for each individual state within the United States during the initial COVID-19 outbreak. We found that the detected case number and trajectory of early detected cases differ considerably between states. We then test for correlations with testing protocols, interventions and population characteristics. We find that epidemic dynamics were most strongly associated with non-pharmaceutical government actions during the early phase of the epidemic. In particular, early social distancing restrictions, particularly on restaurant operations, was correlated with increased doubling times. Interestingly, we also found that states with little tolerance for deviance from enforced rules saw faster early epidemic growth. Together with other correlates such as population density, our results highlight the different factors involved in the heterogeneity in the early spread of COVID-19 throughout the United States. Although individual states are clearly not independent, they can serve as small, natural experiments in how different demographic patterns and government responses can impact the course of an epidemic.
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Project description:Approximately 10% of teens report experiencing sexual dating violence (SDV) or physical dating violence (PDV), collectively represented as teen dating violence (TDV). This study examines the association between laws incorporating TDV education in schools on TDV prevalence. TDV prevalence was estimated using data contributed by 36 states that participated in the 2015 Youth Risk Behavioral Surveillance Survey (YRBS). Presence of TDV laws was determined using Westlaw, a legal search engine. The adjusted odds of TDV victimisation was estimated by the presence or absence of a state law and length of time the law was in effect using hierarchical regression modelling, clustering on state, controlling for individual-level and state-level covariates and incorporating the YRBS-weighted survey design. After controlling for individual-level and state-level covariates, the presence of a law was not associated with TDV (adjusted OR (aOR) 0.97; 95% CI 0.88 to 1.06), PDV (aOR 1.12; 95% CI 0.95 to 1.33) or SDV (aOR 0.99; 95% CI 0.91 to 1.08). These odds did not differ across the length of time the policies were in effect. This study suggest that just the presence of a law incorporating TDV education in schools is not associated with reduced TDV victimisation but further research is needed to understand the association of the content of these laws and their implementation on TDV victimisation.
| S-EPMC8080304 | biostudies-literature
Project description:Importance:Firearm laws in one state may be associated with increased firearm death rates from homicide and suicide in neighboring states. Objective:To determine whether counties located closer to states with lenient firearm policies have higher firearm death rates. Design, Setting, and Participants:This cross-sectional study of firearm death rates by county for January 2010 to December 2014 examined data from the US Centers for Disease Control and Prevention for firearm suicide and homicide decedents for 3108 counties in the 48 contiguous states of the United States. Exposures:Each county was assigned 2 scores, a state policy score (range, 0-12) based on the strength of its state firearm laws, and an interstate policy score (range, -1.33 to 8.31) based on the sum of population-weighted and distance-decayed policy scores for all other states. Counties were divided into those with low, medium, and high home state and interstate policy scores. Main Outcomes and Measures:County-level rates of firearm, nonfirearm, and total homicide and suicide. With multilevel Bayesian spatial Poisson models, we generated incidence rate ratios (IRR) comparing incidence rates between each group of counties and the reference group, counties with high home state and high interstate policy scores. Results:Stronger firearm laws in a state were associated with lower firearm suicide rates and lower overall suicide rates regardless of the strength of the other states' laws. Counties with low state scores had the highest rates of firearm suicide. Rates were similar across levels of interstate policy score (low: IRR, 1.34; 95% credible interval [CI], 1.11-1.65; medium: IRR, 1.36, (95% CI, 1.15-1.65; and high: IRR, 1.43; 95% CI, 1.20-1.73). Counties with low state and low or medium interstate policy scores had the highest rates of firearm homicide. Counties with low home state and interstate scores had higher firearm homicide rates (IRR, 1.38; 95% CI, 1.02-1.88) and overall homicide rates (IRR, 1.32; 95% CI, 1.03-1.67). Counties in states with low firearm policy scores had lower rates of firearm homicide only if the interstate firearm policy score was high. Conclusions and Relevance:Strong state firearm policies were associated with lower suicide rates regardless of other states' laws. Strong policies were associated with lower homicide rates, and strong interstate policies were also associated with lower homicide rates, where home state policies were permissive. Strengthening state firearm policies may prevent firearm suicide and homicide, with benefits that may extend beyond state lines.
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