The Effect of Drug Pricing on Outpatient Payments and Treatment for Three Soil-Transmitted Helminth Infections in the United States, 2010–2017

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  • 1 Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia;
  • 2 Department of Economics, University at Albany, SUNY, Albany, New York;
  • 3 Department of Pharmacy and Health Systems Science, Northeastern University, Boston, Massachusetts;
  • 4 HealthPartners Institute, Minneapolis, Minnesota;
  • 5 Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis, Minnesota

The price of certain antiparasitic drugs (e.g., albendazole and mebendazole) has dramatically increased since 2010. The effect of these rising prices on treatment costs and use of standard of care (SOC) drugs is unknown. To measure the impact of drug prices on overall outpatient cost and quality of care, we identified outpatient visits associated with ascariasis, hookworm, and trichuriasis infections from the 2010 to 2017 MarketScan Commercial Claims and Encounters and Multi-state Medicaid databases using Truven Health MarketScan Treatment Pathways. Evaluation was limited to members with continuous enrollment in non-capitated plans 30 days prior, and 90 days following, the first diagnosis. The utilization of SOC prescriptions was considered a marker for quality of care. The impact of drug price on the outpatient expenses was measured by comparing the changes in drug and nondrug outpatient payments per patient through Welch’s two sample t-tests. The total outpatient payments per patient (drug and nondrug), for the three parasitic infections, increased between 2010 and 2017. The increase was driven primarily by prescription drug payments, which increased 20.6–137.0 times, as compared with nondrug outpatient payments, which increased 0.3–2.2 times. As prices of mebendazole and albendazole increased, a shift to alternative SOC and non-SOC drug utilization was observed. Using parasitic infection treatment as a model, increases in prescription drug prices can act as the primary driver of increasing outpatient care costs. Simultaneously, there was a shift to alternative SOC, but also to non-SOC drug treatment, suggesting a decrease in quality of care.

Author Notes

Address correspondence to Heesoo Joo, Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS H16-4, Atlanta, GA 30329. E-mail: hjoo@cdc.gov

Authors’ addresses: Heesoo Joo, Brian A. Maskery, Christina R. Phares, and Michelle Weinberg, Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, E-mails: hjoo@cdc.gov, wqm7@cdc.gov, ctp7@cdc.gov, and mpw5@cdc.gov. Junsoo Lee, Department of Economics, University at Albany, SUNY, Albany, NY, E-mail: jlee38@albany.edu. Chanhyun Park, Department of Pharmacy and Health Systems Science, School of Pharmacy, Bouvé College of Health Sciences, Northeastern University, Boston, MA, E-mail: c.park@northeastern.edu. Jonathan D. Alpern, HealthPartners Institute, Minneapolis, MN, E-mail: alper054@umn.edu. William M. Stauffer, Division of Infectious Diseases and International Medicine, Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis, MN, E-mail: stauf005@umn.edu.

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