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Drug Cost Effectiveness Evaluations Based on Faulty Assumptions

ST. LOUIS--(BUSINESS WIRE)--Sept. 9, 2003--Faulty assumptions in economic models used to evaluate the cost effectiveness of prescription drugs may incorrectly favor more expensive drugs, according to a new study published today in the Journal of Managed Care Pharmacy.

In the study, researchers at Express Scripts (Nasdaq: ESRX) substituted actual data in place of model assumptions and discovered that economic models used to compare ulcer treatments overstated the cost-effectiveness of more expensive treatments.

The researchers looked at treatments that combined antibiotics with either a generic bismuth drug or a more expensive branded proton pump inhibitor (PPI). The more economical bismuth-based treatment was actually the most cost-effective.

The models had incorrectly assumed that patients failing to take their medicine and antibiotic resistance would compromise the effectiveness of the cheaper bismuth-based treatments. The models also overestimated physician, laboratory and hospitalizations costs triggered by disease recurrence after treatment.

"Key model assumptions were largely unsupported by either evidence or expert opinion," said Brenda R. Motheral, PhD, a study co-author and vice president for outcomes research at Express Scripts.

"While errors in economic modeling may not be as troubling as errors in studies of efficacy or safety, preventing and correcting such errors is in the patient's best interest. Since health care resources are finite, payer funds expended on one treatment are, by definition, unavailable for others," observed Motheral.

"Given that patients pay portions of premiums and copays, promoting cost-effective treatment decisions ultimately controls not only payers' costs but also patients' out-of-pocket expenditures," added Motheral.

"The recent introduction of generic and over the counter PPI drugs should ultimately lessen differences in cost effectiveness between PPI- and bismuth-based ulcer treatments regimens. Nevertheless, our findings reaffirm the oft-expressed need for ongoing examination of the validity of economic models used to evaluate and compare the cost effectiveness of prescription drugs," said Motheral.

Source: Express Scripts

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