phactMI™ Benchmarking Survey: Analysis of 27 Medical Information Departments Responses to Inquiries from Health Care Decision Makers.

BACKGROUND: The nature in which health care insurance companies have interacted with drug manufacturers has evolved over the last 50 years, demanding shifts in how the pharmaceutical industry responds. The purpose of this article is to highlight how medical groups within Pharma Collaboration for Transparent Medical Information (phactMI™) member companies respond to requests from health care decision makers (HCDMs) and to understand the similarities and differences among drug manufacturers (DMs) in this evolving climate of information exchange. METHODS: As health care insurance companies transition towards a managed care model and began assessments of both the clinical and economical aspects of drug products, DMs began to respond to requests from HCDMs. An anonymous 16-question survey was conducted to evaluate how 27 Medical Information departments (MIDs) respond to payer requests for information, and to identify payer needs in order to provide a better overall customer experience. RESULTS: The results from this survey provided insight into the overall management of payer unsolicited medical requests (PUMRs) and focused on a few different areas, including how requests are received, what materials are requested and which are sent, online availability, and availability of materials for products in the pipeline. CONCLUSION: Further discussion is recommended to ensure a focused approach in developing tools and identifying appropriate resources are available to address inquiries from HCDMs.

Cost-Effectiveness of High-Dose Edoxaban Compared with Adjusted-Dose Warfarin for Stroke Prevention in Non-Valvular Atrial Fibrillation Patients.

OBJECTIVE: To estimate the quality-adjusted life-years (QALYs), costs, and cost-effectiveness of high-dose edoxaban compared with adjusted-dose warfarin in patients at risk for stroke who have nonvalvular atrial fibrillation (NVAF) and a creatinine clearance (Clcr ) of 15-95 ml/minute. METHODS: A Markov model was created to compare the cost-effectiveness of high-dose edoxaban and adjusted-dose warfarin in patients with a Clcr of 15-95 ml/minute. The model was performed from a U.S. societal perspective and assumed patients initiated therapy at 70 years of age, had a mean CHADS2 (congestive heart failure, hypertension, age 75 or older, diabetes, stroke) score of 3, and no contraindications to anticoagulation. The model assumed a cycle length of 1 month and a lifetime horizon (maximum of 30 years/360 cycles). Data sources included renal subgroup analysis of the Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation (ENGAGE-AF) trial and other published studies. Outcomes included lifetime costs (2014 US$), QALYs, and incremental cost-effectiveness ratios. The robustness of the model's conclusions was tested using one-way and 10,000-iteration probabilistic sensitivity analysis (PSA). RESULTS: Patients treated with high-dose edoxaban lived an average of 10.50 QALYs at a lifetime treatment cost of $99,833 compared with 10.11 QALYs and $123,516 for those treated with adjusted-dose warfarin. The model's conclusions were found to be robust upon one-way sensitivity analyses. PSA suggested high-dose edoxaban was economically dominant compared with adjusted-dose warfarin in more than 99% of the 10,000 iterations run. CONCLUSIONS: High-dose edoxaban appears to be an economically dominant strategy when compared with adjusted-dose warfarin for the prevention of stroke in NVAF patients with a Clcr of 15-95 ml/minute and an appreciable risk of stroke.