Christina M.L. Kelton

Utilization, price, and spending trends for antidepressants in the US Medicaid Program

BACKGROUND Antidepressants are often used in the treatment of major depressive disorder and other mental illnesses, and constitute one of the most widely prescribed and costly medication classes in the US Medicaid Program. However, antidepressant utilization and price patterns within this market have not yet been adequately characterized. OBJECTIVES This study was undertaken to analyze antidepressant drug utilization and price trends and to quantify market-share competition in Medicaid. METHODS Quarterly utilization and payment data were retrieved from the national Medicaid pharmacy claims files provided by the Centers for Medicare & Medicaid Services. Quarterly per-prescription prices were estimated by dividing the payment amounts by the number of prescriptions. Descriptive time series analysis was conducted to assess the trends of utilization, expenditures, market shares, and prices from January 1991 through December 2005, for 3 major antidepressant subclasses--Selective Serotonin Reuptake Inhibitors (SSRIs), Tricyclic Antidepressants, and Other Antidepressants--as well as for individual agents within these subclasses. Using exponential smoothing models, 3-year market-share forecasts were produced. RESULTS From 1991 to 2005, the total number of antidepressant prescriptions rose 380% from 6.82 million to 32.72 million. Total expenditures on antidepressants increased from

Durability Versus Concentration as an Explanation for Price Inflexibility

159 million in 1991 to

National burden of pediatric hospitalizations for inflammatory bowel disease: results from the 2006 Kids' Inpatient Database.

2.26 billion in 2004, then decreased to

Impact of the Food and Drug Administration's antipsychotic black box warning on psychotropic drug prescribing in elderly patients with dementia in outpatient and office-based settings.

1.99 billion in 2005, following the entry of lower-priced generic fluoxetine in 2001 and generic paroxetine in 2003. The payment market share for the SSRIs increased from 40% in 1991 to 82% in 1997, then decreased to 64% in 2005. It is projected to be 64% (95% confidence interval [CI]: 51-77%) in 2008 quarter 4. CONCLUSIONS Increases in antidepressant drug expenditures were primarily because of rising utilization; however, there was also some increase in average price per prescription for many of the antidepressants studied. Switching to generic drugs may offer significant cost-saving potential.

ADVERTISING AND INTRAINDUSTRY BRAND SHIFT IN THE U.S. BREWING INDUSTRY

We document the extent of price rigidity across United States manufacturing industries in the 1980s and early 1990s and compare rigidity across different phases of the business cycle. We measure price rigidity in three ways – each under four different sets of assumptions. We take an approach that relies on disaggregated data; we look at price patterns for over 4000 individual manufactured commodities. Both durability and seller concentration are found to be important factors explaining differences in price rigidity across industrial product classes. Using our data, we replicate the regression results found in Carlton (1986) that were based on actual transaction prices from the 1960s.

Utilization, Spending, and Price Trends for Benzodiazepines in the US Medicaid Program: 1991-2009

Objectives: The objective of the present study was to quantify the national pediatric inpatient inflammatory bowel disease (IBD) burden in terms of the number of IBD-related hospitalizations, the number of days spent in the hospital, and hospitalization costs. Methods: Hospitalizations for children and adolescents 20 years and younger with a primary diagnosis of either Crohn disease (CD) or ulcerative colitis (UC) were selected from the 2006 Kids’ Inpatient Database (KID). Length of the hospital stay in days (LOS) and charges for the hospitalization were found directly in the Kids’ Inpatient Database, and cost was calculated using the hospitals cost-to-charge ratio. Predictor variables included patient characteristics, such as age and severity of illness, and hospital characteristics. Ordinary-least-squares regressions were developed and estimated to explain hospitalization costs. Results: In 2006, there were 10,777 IBD-related hospitalizations. The total and mean costs for CD were

Optimal television schedules in alternative competitive environments

66.3 million and

Hypothesis Tests for Markov Process Models Estimated from Aggregate Frequency Data

10,176 (95% confidence interval [CI]

Treatment of obesity: Pharmacotherapy trends in the United States from 1999 to 2010

9647–

Exposure to potentially dangerous drug-drug interactions involving antipsychotics.

10,705), and for UC were