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Executive Summary

PACE DRUG UTILIZATION REVIEW ANNUAL SAVINGS OF $ 1.2 MIL. from discontinued or reduced drug use are estimated based on a pharmaceutical claims tracking analysis conducted for the Pennsylvania Department of Aging. The state's pharmaceutical assistance program for the elderly, PACE, initiated the DURbase drug utilization review program (under contract with Health Information Designs, Inc.) in July 1987 "to help identify and resolve potential problems related to drug therapy," according to an Oct. 17 report by HID. Based on a random sample of 10% of the patient cases initially reviewed in the first five months of DURbase, the study found a total of 1,298 prescriptions were avoided (7.3 Rxs per case) as a result of PharmRisk Alert letters sent to physicians. "These Rxs translate into a savings of $ 26,412 or $ 148.38 per case," HID reported. "Extrapolating the savings . . . to the 8,408 cases identified during the first year of the program yields a projected savings of $ 1.2 mil." The PACE experience with drug utilization review has a broader significance, in that the recently enacted Medicare outpatient drug program was modeled partly on the Pennsylvania assistance program, including a drug utilization review requirement. HID's review analyzed individual cases to detect changes in drug therapy patterns relating to the issuance of alert letters. The average number of prescriptions and the average quantity of prescriptions per month, prior to the alert, were compared to the period starting 30 days after the letter was sent to the doctor. HID included only those patients who had at least 150 days of history with PACE after the alert letters to avoid overstating the incidence of discontinued drugs. In 66.8% of the 178 cases eligible for review "there was a documented change which improved the patient's drug therapy," HID said. "In one out of every seven cases ]14.6%[, there was a complete discontinuance of the problem drug shortly after" issuance of the alert letter. Other responses included: reduction in drug amount or frequency (30.9%); change to different drug (9.6%); and no change in therapy (33.2%). In 11.6% of the cases, the change in drug therapy occurred prior to issuance of the alert letter. "This finding suggests that the DURbase criteria correctly identified those problems," HID maintained. Anti-arthritic drugs, particularly nonsteroidal anti-flammatory drugs, accounted for 37% of total savings ($ 9,712) from the drug utilization review program, HID continued. "Nalfon, Indocin and Clinoril accounted for savings of $ 2,385, $ 1,730 and $ 1,582, respectively," the report adds. The antiulcer category represented "the next largest savings," at 16%, or $ 4,125, HID added. "Savings attributable to reduced or discontinued prescriptions for Tagamet and Zantac amounted to $ 2,313 and $ 1,737, respectively." Other therapeutic categories with relatively high drug utilization review savings were: antihypertensives ($ 3,595); antidepressants ($ 2,402); and cardiac drugs ($ 2,365), according to the HID analysis. Limitations in the study's methodology prevented an analysis of whether the DUR-base program resulted in a lower rate of hospitalization from drug-induced illness, HID explained. However, the results from such studies in other DURbase programs show that "hospital cost savings far exceeded pharmaceutical cost savings, often by as much as 500%-1,000%," the report maintains. "It is therefore reasonable to conclude that hospital cost savings related to DURbase-PACE have been substantial."

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