Home › Research › Health systems and care delivery
Cost containment by peer prior authorization program for second line treatment in patients with retinal disease
Amir Rosenblatt, Igal Hekselman, Irit Rosenblatt, Idan Hekselman, Dan Gaton. Not indexed, 2019-07-24
Topic: Risk, prevention and care in population studies
Abstract Background: Rising drug prices prompt the establishment of cost-containment treatment policies. Ranibizumab was approved for treatment of retinal diseases, although the less-costly, off label, bevacizumab has been found equally effective. We describe a novel prior-authorization approach, which we applied to ranibizumab as second-line treatment, in non-responders to first-line bevacizumab: A steering committee set the funding criteria based on cost and updating clinical considerations; an ophthalmic specialists team evaluated their colleagues’ individual patient subsidization request, based on the funding criteria. Methods This retrospective cohort included all the applications for a first or ongoing treatment with ranibizumab, for one or both eyes, applying for treatment between March 1, 2012 to December 31, 2015 During that time, 16,778 applications for funding from 5,642 patients (~2.97 applications/patient) were submitted and assessed, accounting for 31% of bevacizumab (first line)-treated patients Aapproval was granted in 94.6% of all requests, via their peer-revision. Conclusions The program made it feasible to finance a costly treatment for patients that may benefit from it, while maintaining qualitative medical outcomes and sparing treating ophthalmologist from ethical gatekeeping dilemmas
Key findings
- Abstract Background: Rising drug prices prompt the establishment of cost-containment treatment policies.
- Ranibizumab was approved for treatment of retinal diseases, although the less-costly, off label, bevacizumab has been found equally effective.
- We describe a novel prior-authorization approach, which we applied to ranibizumab as second-line treatment, in non-responders to first-line bevacizumab: A steering committee set the funding criteria based on cost and updating clinical considerations; an ophthalmic specialists team evaluated their colleagues’ individual patient subsidization request, based on the funding criteria.
- Methods This retrospective cohort included all the applications for a first or ongoing treatment with ranibizumab, for one or both eyes, applying for treatment between March 1, 2012 to December 31, 2015 During that time, 16,778 applications for funding from 5,642 patients (~2.97 applications/patient) were submitted and assessed, accounting for 31% of bevacizumab (first line)-treated patients Aapproval was granted in 94.6% of all requests, via their peer-revision.
- Conclusions The program made it feasible to finance a costly treatment for patients that may benefit from it, while maintaining qualitative medical outcomes and sparing treating ophthalmologist from ethical gatekeeping dilemmas
Why it matters
This study describes a prior authorization program that let a costly eye drug be used as second-line treatment for retinal disease after a cheaper drug failed. It provides no information on treating, curing or preventing Alzheimer's disease.
Study details
- Study designretrospective cohort
- Participants5,642
- Effect size94.6%
- Evidence strengthModerate
How this study scored 59/100
Published in a peer-reviewed journal, and it is a retrospective cohort study, reconstructed from past records. Scored zero for randomised / blinded because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 38 of the 64 points we could judge it on, which is 59 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Not indexed) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 7 / 12 | A retrospective cohort study, reconstructed from past records |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2019 — within 10 year(s) of the newest study here |
| Sample size | 3 / 4 | 5,642 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 38 / 64 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 38 of the 64 points we could judge it on is 59 out of 100. |
| Total | 59 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
Free copy unknown: no free-copy check has an answer for this record yet. That does not mean it is paywalled.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. This record has no journal, so the citation leaves it out. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Rosenblatt, A., Hekselman, I., Rosenblatt, I., Hekselman, I., & Gaton, D. (2019). Cost containment by peer prior authorization program for second line treatment in patients with retinal disease. https://doi.org/10.21203/rs.2.11889/v1
Vancouver
Rosenblatt A, Hekselman I, Rosenblatt I, Hekselman I, Gaton D. Cost containment by peer prior authorization program for second line treatment in patients with retinal disease. 2019. doi:10.21203/rs.2.11889/v1.
BibTeX
@article{rosenblatt2019-bdb6cf8a,
author = {Rosenblatt, Amir and Hekselman, Igal and Rosenblatt, Irit and Hekselman, Idan and Gaton, Dan},
title = {{Cost containment by peer prior authorization program for second line treatment in patients with retinal disease}},
year = {2019},
doi = {10.21203/rs.2.11889/v1},
url = {https://doi.org/10.21203/rs.2.11889/v1}
}