Association of co-pay elimination with medication adherence and total cost.

OBJECTIVES: To determine whether elimination of co-pays for prescription drugs affects medication adherence and total health care spending. STUDY DESIGN: Retrospective comparative study. METHODS: We conducted a difference-in-differences comparison in the year before and after expansion of a Zero Dollar Co-pay (ZDC) prescription drug benefit in commercially insured Louisiana residents. Blue Cross and Blue Shield of Louisiana members with continuous disease management program enrollment were analyzed, of whom 6463 were enrolled in the ZDC program and 1821 were controls who were ineligible because their employers did not opt in. RESULTS: After ZDC expansion, medication adherence fell in the control group and rose in the ZDC group, with a relative increase of 2.1 percentage points (P = .002). Medical spending fell by $71 per member per month (PMPM) (P = .027) in the ZDC group relative to controls. Overall, there was no significant increase in the cost of drugs between treatment and controls. However, when drugs were further categorized, there was a significant increase of $8 PMPM for generic drugs and no significant difference for brand name drugs. Comparisons of medication adherence rates by household income showed the largest relative increase post ZDC expansion among low-income members. CONCLUSIONS: Elimination of co-pays for drugs indicated to treat chronic illnesses was associated with increases in medication adherence and reductions in overall spending of $63. Benefit designs that eliminate co-pays for patients with chronic illnesses may improve adherence and reduce the total cost of care.

Protein Discrimination Using a Fluorescence-Based Sensor Array of Thiacarbocyanine-GUMBOS.

Sensitive and selective detection of proteins from complex samples has gained substantial interest within the scientific community. Early and precise detection of key proteins plays an important role in potential clinical diagnosis, treatment of different diseases, and proteomic research. In the study reported here, six different compounds belonging to a group of uniform materials based on organic salts (GUMBOS) have been synthesized using three thiacarbocyanine (TC) dyes and employed as fluorescent sensors. Fluorescence properties of micro- and nanoaggregates of these TC-based GUMBOS formed in phosphate buffer solutions are studied in the absence and presence of seven proteins. Fluorescence response patterns of these TC-based GUMBOS were analyzed by linear discriminant analysis (LDA). The constructed LDA model allowed discrimination of these seven proteins at various concentrations with 100% accuracy. The sensing and discrimination abilities of these TC-based GUMBOS were further evaluated in mixtures of two major proteins, i.e., human serum albumin and hemoglobin. Fluorescence response patterns of these mixtures were analyzed by LDA. This model allowed discrimination of various mixtures with 100% accuracy. Moreover, spiked urine samples were prepared and the responses of these sensors were collected and analyzed by LDA. Remarkably, discrimination of these seven proteins was also achieved with 100% accuracy.

Imidazolium-dysprosium-based magnetic NanoGUMBOS for isolation of hemoglobin.

A novel imidazolium-dysprosium-based magnetic nanomaterial, i.e. [C16mim]5[Dy(SCN)8] nanoGUMBOS (nanomaterials fabricated from a group of uniform material based on organic salts), was prepared using a facile method for selective hemoglobin (Hb) isolation. In this nanomaterial, the imidazolium cation serves as a selective Hb affinity group, while dysprosium contributes paramagnetic properties. Through a combination of the advantages of ionic liquids, magnetic adsorbent, and nanoscale solid phase extraction, [C16mim]5[Dy(SCN)8] nanoGUMBOS exhibit great selectivity toward Hb and a favorable extraction efficiency of 95.4% when 1 mL of 100 µg/mL Hb solution is processed with 0.6 mg of [C16mim]5[Dy(SCN)8] nanoGUMBOS. As the Hb concentration increased to 800 µg/mL, the adsorption capacity approached ∼840 µg/mg. The adsorbed protein is recovered with an elution efficiency of 87% by using 1% SDS solution. This novel nanoGUMBOS solid-phase extraction procedure was successfully applied to selective isolation of Hb from human whole blood and verified using SDS-PAGE. This simple strategy is a novel approach towards fabrication and use of a nanoadsorbent for selective isolation of proteins.

Mitochondria targeting IR780-based nanoGUMBOS for enhanced selective toxicity towards cancer cells.

Herein, a simple counter-ion variation strategy is proposed and demonstrated for design of an array of near infrared IR780-based nanoGUMBOS (nanomaterials from a Group of Uniform Materials Based on Organic Salts) to produce enhanced anticancer activity. These nanomaterials were synthesized by direct nanoengineering of IR780-based GUMBOS using a reprecipitation method, without addition of any other materials. Thus, these novel nanomaterials can serve as carrier-free nanodrugs, providing several distinct advantages over conventional chemotherapeutics. Examination of the size and stability of these nanoGUMBOS indicates formation of approximately 100 nm nanoparticles that are stable under biological conditions. Interestingly, in vitro chemotherapeutic applications of these nanoGUMBOS indicate two to four-fold enhanced toxicity towards breast cancer cells as compared to the parent dye, while still maintaining minimal toxicity towards normal cells. The mechanism of cancer toxicity for these nanoGUMBOS was also examined by a study of their sub-cellular localization as well as using a mitochondrial toxicity assay. Analyses of data from these studies revealed that all nanoGUMBOS primarily accumulate in the mitochondria of cancer cells and produce dysfunction in the mitochondria to induce cell death. Using these studies, we demonstrate tunable properties of IR780-based nanoGUMBOS through simple variation of counter-ions, thus providing a promising strategy for future design of better nanomedicines to be used for cancer therapy.

Tunable GUMBOS-based sensor array for label-free detection and discrimination of proteins.

There is increasing interest in developing new sensor strategies for accurate detection and identification of proteins, primarily due to their significance in various biological processes. In this regard, fluorometric sensors and sensor arrays have been widely explored as facile and inexpensive analytical tools. In this manuscript, we report a sensor array approach, based on a novel group of 6-(p-toluidino)-2-naphthalenesulfonate (TNS)-based organic salts for sensitive and label-free sensing of proteins. In this proof-of-concept study, three proteins (human serum albumin (HSA), α-antitrypsin and ß-lactoglobulin (ß-lac)) and binary mixtures of HSA and α-antitrypsin were used to evaluate the senor array performance. The fingerprint sensor-response patterns, dependent on proteins and protein mixtures at different concentrations, generated from the TNS-based sensors were employed to develop predictive models using principal component analysis (PCA) and linear discriminant analysis (LDA). Interestingly, there is excellent correlation between clustering patterns of PCA and different concentrations of proteins and protein mixtures, which was employed for discrimination of proteins and protein mixtures regardless of concentrations. Furthermore, identification accuracy of the proposed fluorescence-sensor technique, towards discrimination of various concentrations of proteins and protein mixtures, was calculated to be 100%. Overall, this sensor strategy is found to be a very promising tool for accurate discrimination of absolute and relative concentrations of proteins and protein mixtures.