Formulary Exclusion of Esomeprazole: Impact on Healthcare Costs and Utilization | Page 4
Published Online: August 15, 2013
Berhanu Alemayehu, DrPH; Joseph A. Crawley, MS; Xiongkan Ke, MS; and Marta Illueca, MD
This is a retrospective analysis of medical claims data from a large national healthcare payer during the period before and after esomeprazole was excluded from the formulary. Claims data do not allow assessment of symptom severity or any indirect costs, such as those related to a patient’s ability to work or healthcare quality of life. Moreover, the changes we observed were associated in time with the formulary exclusion, but cannot be proved to be causally related. Although esomeprazole was excluded from the formulary for all members, certain patients may have been exempted (eg, if their employer petitioned to continue the treatment coverage). In addition, a limitation inherent to retrospective observational studies is that the analysis results may be confounded by variables that were not measured in the study. Another possible limitation of this study is thatpatients who were able to continue on esomeprazole by paying for it out of pocket might represent a more affluent group than the overall population, and thus might have better overall health or better adherence to the medication regimen compared with patients who switched to another PPI. This might bias the results toward lower costs and healthcare utilization in the self-pay group, although within-group comparison of the pre-exclusion versus postexclusion costs would control for this bias to some extent.
After formulary exclusion of esomeprazole from a large US national health plan, patients in this study who switched to another PPI incurred higher overall healthcare utilization and higher healthcare costs compared with patients who remained on esomeprazole. The results of this analysis suggest that in some cases, formulary exclusions that are expected to save money can yield unexpected and substantially higher annual healthcare utilization and medical and prescription costs.
Author Affiliations: From AstraZeneca LP (BA, JAC, XK, MI), Wilmington, DE.
Funding Source: This study was funded by AstraZeneca LP.
Author Disclosures: All authors report employment with Astra-Zeneca LP, which owns 1 of the drugs analyzed in this study (esomeprazole magnesium), as well as stock ownership in the company.
Authorship Information: Concept and design (BA, JAC, MI); acquisition of data (BA, XK); analysis and interpretation of data (BA, JAC, XK, MI); drafting of the manuscript (BA); critical revision of the manuscript for important intellectual content (BA, JAC, MI); statistical analysis (BA); obtaining funding (JAC); administrative, technical, or logistic support (BA); and supervision (BA, MI).
Address correspondence to: Marta Illueca, MD, AstraZeneca LP, 1800 Concord Pike, D2C-101, PO Box 15437, Wilmington, DE 19850. E-mail: firstname.lastname@example.org.
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