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Impact of Anthelmintic Price Increases on Practice Patterns of Healthcare Providers Caring for Immigrant and Refugee Populations in the United States

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  • 1 Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland;
  • 2 Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota;
  • 3 HealthPartners Institute, HealthPartners Travel and Tropical Medicine Center, Minneapolis, Minnesota;
  • 4 Department of Microbiology and Immunology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland;
  • 5 Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota;
  • 6 Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota;
  • 7 Center for Global Health and Social Responsibility, School of Public Health, University of Minnesota, Minneapolis, Minnesota

ABSTRACT

In the United States, prices of long-established, generic anthelmintic medications have markedly risen. In the past decade, albendazole and mebendazole have increased in price by > 8,000%, whereas praziquantel has increased by > 500%. To determine the effect of these price increases on the practice patterns of healthcare providers, we conducted a cross-sectional electronic survey of clinics in the United States that primarily care for immigrant and refugee patient populations. Among 32 clinics, 53.1% reported that price increases impacted how providers diagnosed and treated helminth infections. A third (34.4%) of clinics reported that price increases have left them unable to treat known helminth infections. Other ways in which price increases impacted practice patterns included prescribing anthelmintics other than albendazole, mebendazole, or praziquantel when possible (34.4%); avoiding screening asymptomatic patients for helminth infections (15.6%); advising patients to acquire medications from another country (15.6%) or the patient’s home country (9.4%); reducing anthelmintic dosing regimens to fewer pills (9.4%); and advising patients to purchase medications on the Internet (6.3%). These findings suggest price increases have negatively impacted the diagnosis and treatment of helminth infections in this population, and have resulted in the inability to treat known helminth infections. These findings have significant implications for the morbidity and mortality of infected individuals, as well as for public health in the United States.

Author Notes

Address correspondence to Edward Mitre, Department of Microbiology and Immunology, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814. E-mail: edward.mitre@usuhs.edu

Copyright statement: This work was prepared by a military or civilian employee of the U.S. government as part of the individual’s official duties and therefore is in the public domain and does not possess copyright protection (public domain information may be freely distributed and copied; however, as a courtesy, it is requested that the Uniformed Services University and the author be given an appropriate acknowledgment).

Disclaimer: The opinions and assertions expressed herein are those of the author(s) and do not necessarily reflect the official policy or position of the Uniformed Services University or the Department of Defense.

Disclosure: M. F. and E. M. are employees of the U.S. government.

Authors’ addresses: Madeline Fleit, Department of Internal Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, and National Capital Consortium, Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, MD, E-mail: madeline.r.fleit.mil@mail.mil. Hannah Volkman, Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, E-mail: volk0108@umn.edu. Jonathan D. Alpern, HealthPartners Institute, HealthPartners Travel and Tropical Medicine Center, Minneapolis, MN, E-mail: alper054@umn.edu. Alyssa R. Lindrose and Edward Mitre, Department of Microbiology and Immunology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, E-mails: alyssa.lindrose.ctr@usuhs.edu and edward.mitre@usuhs.edu. William Stauffer, Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, Department of Pediatrics, University of Minnesota, Minneapolis, MN, and Center for Global Health and Social Responsibility, School of Public Health, University of Minnesota, Minneapolis, MN, E-mail: stauf005@umn.edu.

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