Variation in prescription use and spending for lipid-lowering and diabetes medications in the Veterans Affairs Healthcare System.
OBJECTIVE
To examine variation in outpatient prescription use and spending for hyperlipidemia and diabetes mellitus in the Veterans Affairs Healthcare System (VA) and its association with quality measures for these conditions.


METHODS
Cross-sectional.


METHODS
We compared outpatient prescription use, spending, and quality of care across 135 VA medical centers (VAMCs) in fiscal year 2008, including 2.3 million patients dispensed lipid-lowering medications and 981,031 patients dispensed diabetes medications. At each facility, we calculated VAMC-level cost per patient for these medications, the proportion of patients taking brand-name drugs, and Healthcare Effectiveness Data and Information Set (HEDIS) scores for hyperlipidemia (low-density lipoprotein cholesterol level <100 mg/dL) and for diabetes (glycosylated hemoglobin level >9% or not measured).


RESULTS
The median cost per patient for lipid-lowering agents in fiscal year 2008 was $49.60 and varied from $39.68 in the least expensive quartile of VAMCs to $69.57 in the most expensive quartile (P < .001). For diabetes agents, the median cost per patient was $158.34 and varied from $123.34 in the least expensive quartile to $198.31 in the most expensive quartile (P < .001). The proportion of patients dispensed brand-name oral drugs among these classes in the most expensive quartile of VAMCs was twice that in the least expensive quartile (P < .001). There was no correlation between VAMC-level prescription spending and performance on HEDIS measures for lipid-lowering drugs (r = 0.12 and r = 0.07) or for diabetes agents (r = -0.10).


CONCLUSIONS
Despite the existence of a closely managed formulary, significant variation in prescription spending and use of brand-name drugs exists in the VA. Although we could not explicitly risk-adjust, there appears to be no relationship between prescription spending and quality of care.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA 15206, USA. walid.gellad@va.gov
Walid F
WF
Gellad
Chester B
CB
Good
John C
JC
Lowe
Julie M
JM
Donohue
D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000191:economics*; D017850:Economics, Pharmaceutical; D017048:Health Care Costs; D005102:Health Expenditures; D006787:Hospitals, Veterans / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy* / Q000191:economics; D007004:Hypoglycemic Agents / Q000191:economics* / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000191:economics / Q000627:therapeutic use*; D016015:Logistic Models; D016017:Odds Ratio; D010045:Outpatients / Q000706:statistics & numerical data; D055553:Prescription Drugs / Q000191:economics*; D018709:Statistics, Nonparametric; D014481:United States; D014493:United States Department of Veterans Affairs
D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D055553:Prescription Drugs