Budget impact of tegaserod on a managed care organization formulary.
We sought to develop a budget impact model that assesses the economic effect of adding tegaserod for the management of irritable bowel syndrome (IBS) with constipation to the formulary of a managed care organization (MCO). The model estimates the per patient economic impact and the per member, per month (PMPM) economic impact of patients 6 months before and 6 months after the initiation of tegaserod. Resource utilization data, taken from medical and pharmacy administrative claims data, were based on a retrospective, longitudinal study of 3365 patients administered tegaserod through a large, geographically diverse MCO. Costs were estimated for 2 patient subgroups, women with IBS and other gastrointestinal (GI) diagnoses. Sensitivity analyses were performed by varying several model input parameters. The base-case model resulted in an incremental PMPM budget impact associated with the use of tegaserod of 0.01 dollars. Total per patient budget impact (for all resources, including tegaserod) for a 6-month period was 274.34 dollars for women with IBS and 301.84 dollars for women with other GI diagnoses. Overall, 25.9% (29.0% for women with IBS group and 21.9% for women with other GI diagnoses group) of the cost of tegaserod was offset by decreases in resource utilization. Key drivers of post-tegaserod reductions in resource costs were hospital stays, outpatient office visits, emergency department visits, endoscopic procedures, and nonendoscopic procedures. Tegaserod therapy can decrease GI-related resource utilization, resulting in a significant cost-offset percentage. When the associated budget impact of adding tegaserod to its formulary is absorbed across an entire MCO population, the PMPM impact of tegaserod is small.
Bloom
Michael A
MA
Innovative Health Solutions, Brookline, Massachusetts, USA.
Barghout
Victoria
V
Kahler
Kristijan H
KH
Bentkover
Judith
J
Kurth
Hannah
H
Gralnek
Ian M
IM
Spiegel
Brennan M R
BM
D000328:Adult; D002017:Budgets; D003248:Constipation / Q000150:complications; D017281:Cost of Illness; D016527:Drug Costs; D011307:Drug Prescriptions; D005260:Female; D005569:Formularies as Topic; D005765:Gastrointestinal Agents / Q000191:economics / Q000627:therapeutic use*; D017048:Health Care Costs; D006801:Humans; D007211:Indoles / Q000191:economics / Q000627:therapeutic use*; D043183:Irritable Bowel Syndrome / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D008137:Longitudinal Studies; D008329:Managed Care Programs / Q000191:economics* / Q000706:statistics & numerical data*; D008875:Middle Aged; D015233:Models, Statistical; D012189:Retrospective Studies; D017366:Serotonin Receptor Agonists / Q000191:economics / Q000627:therapeutic use*; D014481:United States; D014600:Utilization Review
D005765:Gastrointestinal Agents; D007211:Indoles; D017366:Serotonin Receptor Agonists; C105050:tegaserod