Abstract
Objective: To test the hypothesis that, ceteris paribus, people using newer, or later vintage drugs will be in better health, and will therefore be less likely to be admitted to hospitals and nursing homes, by examining the effect of pharmaceutical innovation on the utilisation of hospital and long-term care by elderly Americans during 1997–2003.
Design: An estimation of difference-in-differences models of hospital discharge rates using longitudinal state-level data on 12 states. Data on the utilisation of over 43 000 products, by state and year, were obtained from state Medicaid agencies. The extent of utilisation of new drugs in the Medicaid programme is strongly correlated with the extent of utilisation of new drugs in general.
Patients or study participants: All elderly residents of 12 states during the period 1997–2003.
Intervention: The relative utilisation of new and old drugs.
Main outcome measures: Discharges per elderly individual, discharges to nursing homes per elderly individual, and inpatient deaths per elderly individual.
Results: States that had larger increases in drug vintage had smaller increases in the number of hospital discharges per elderly individual. They also had smaller increases in the number of hospital discharges to nursing homes and the number of in-hospital deaths per elderly individual.
Conclusions: Even the upper-bound estimate of the increase in 2003 drug expenditure attributable to the 1997–2003 increase in drug vintage is lower than the sum of the lowest estimates of the 2003 hospital and nursing home expenditure reductions attributable to the 1997–2003 increase in drug vintage.
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References
Lichtenberg FR. Do (more and better) drugs keep people out of hospitals? Am Econ Rev 1996; 86: 384–8
Lichtenberg FR. Are the benefits of newer drugs worth their cost? Evidence from the 1996 MEPS Health Aff 2001; 20: 241–51
Motheral B, Fairman KA. Effect of a three-tier prescription copay on pharmaceutical and other medical utilization. Med Care 2001; 39: 1293–304
Jones A. The National Nursing Home Survey: 1999 summary. National Center for Health Statistics. Vital Health Stat 2002; 13(152)
US Department of Health & Human Services, Centers for Medicare & Medicaid Services, National Health Expenditure Data. Available from URL: http://www.cms.hhs.gov/NationalHealthExpendData/02_NationalHealthAccountsHistorical.asp, last page modified 2006 Feb 28. [Accessed 2006 Dec 10].
Bahk B, Gort M. Decomposing learning by doing in new plants. J Polit Econ 1993; 101: 561–83
Hulten CR. Growth accounting when technical change is embodied in capital. Am Econ Rev 1992; 82: 964–80
Sakellaris P, Wilson D. The production-side approach to estimating embodied technological change. Finance and Economics Discussion Series 2001–20. Board of Governors of the Federal Reserve System Social Science Research Network. Available from URL: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=257069. [Accessed 2006 Dec 10].
Sakellaris P, Wilson D. Quantifying embodied technological change. Rev Econ Dynam 2004; 7: 1–26
Lleras-Muney A, Lichtenberg FR. The effect of education on medical technology adoption: are the more educated more likely to use new drugs? Available from URL: http://www.nber.org/papers/w9185. [Accessed 2006 Dec 10]. Ann d’Econ Stat 2006; in press
Duggan MG, Evans WN. Estimating the impact of medical innovation: the case of HIV antiretroviral treatments. National Bureau of Economic Research Working Paper No. 11109, February 2005. Available from URL: http://www.nber.org/papers/W11109. [Accessed 2006 Dec 10].
Lichtenberg FR. The effect of access restrictions on the vintage of drugs used by Medicaid enrollees. Am J Manag Care 2005; 11 (Special Issue): SP7–SP13
US Department of Health & Human Services. Report to the President. Prescription drug coverage, spending, utilization, and prices. April 2000. Available from URL: http://aspe.hhs.gov/health/reports/drugstudy/. [Accessed 2006 Dec 10].
Skinner J, Staiger D. Technology adoption from hybrid corn to beta blockers. National Bureau of Economic Research Working Paper No. 11251, March 2005. Available from URL: http://www.nber.org/papers/w11251. [Accessed 2006 Dec 10].
Harrington C, Carrillo H, Mercado-Scott C. Nursing facilities, staffing, residents, and facility deficiencies, 1998 through 2004. Department of Social and Behavioral Sciences, University of California San Francisco, August 2005. Available from URL: http://www.nccnhr.org/public/50_155_3801.cfm. [Accessed 2006 Dec 10].
US Department of Health & Human Services, Centers for Medicare & Medicaid Services. Medicare enrollment reports. Available at URL: http://www.cms.hhs.gov/MedicareEnrpts/. Page last modified: 2005 Dec 14. [Accessed 2006 Dec 10].
US Department of Health & Human Services, Centers for Medicare & Medicaid Services. Medicaid drug rebate program, state drug utilization data. Available at URL: http://www.cms.hhs.gov/MedicaidDrugRebateProgram/SDUD/list.asp. Data last updated: 2006 Oct 31. [Accessed 2006 Dec 10].
US Food and Drug Administration, Center for Drug Evaluation and Research. National drug code directory. Available at URL: http://www.fda.gov/cder/ndc//. Date updated: 2006 Nov 8. [Accessed 2006 Dec 10].
US Department of Health & Human Services, Centers for Medicare & Medicaid Services. Medicaid drug rebate program, drug product data. Available at URL: http://www.cms.hhs.gov/MedicaidDrugRebateProgram/09_DrugProdData.asp. Page last modified: 2006 Dec 16. [Accessed 2006 Dec 10].
US Department of Veterans Affairs. National formulary. Available at URL: http://www.pbm.va.gov/NationalFormulary.aspx. Reviewed/updated date: 2006 Dec 1. [Accessed 2006 Dec 10].
US Food and Drug Administration, Center for Drug Evaluation and Research. Drugs@FDA data files. Available at URL: http://www.fda.gov/cder/drugsatfda/datafiles/default.htm. Page last updated: 2006 Nov 30. [Accessed 2006 Dec 10].
US Department of Health & Human Services, Centers for Medicare & Medicaid Services. Medicare & Medicaid statistical supplement, Table 89a. Available at URL: http://www.cms.hhs.gov/MedicareMedicaidStatSupp/LT/list.asp. Data last updated: 2006 Oct 30. [Accessed 2006 Dec 10].
NDCHealth Corporation, PharmaTrends2002. Available at URL: http://www.ndchealth.com/pharmatrends. [Accessed 2003 Feb 26].
US Food and Drug Administration, Center for Drug Evaluation and Research. Drug and biologic approvals for calendar year 2005. Available at URL: http://www.fda.gov/cder/rdmt/ndaaps05cy.htm. Updated 2006 Jan 19. [Accessed 2006 Dec 10].
US Department of Health & Human Services, Centers for Medicare & Medicaid Services, Medicaid statistical information system data. Available at URL: http://www.cms.hhs.gov/MedicaidDataSourcesGenInfo/02_MSISData.asp. Page last modified: 2005 Dec 14. [Accessed 2006 Dec 10].
MetLife Mature Market Institute. The MetLife market survey of nursing home & home care costs, August 2003. Available at URL: http://www.metlife.com/WPSAssets/22802718901060258447V1F2003%20NH%20HC%20Market%20survey.pdf. [Accessed 2006 Dec 10].
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Lichtenberg, F.R. The Effect of Using Newer Drugs on Admissions of Elderly Americans to Hospitals and Nursing Homes: State-level Evidence from 1997 to 2003. PharmacoEconomics 24 (Suppl 3), 5–25 (2006). https://doi.org/10.2165/00019053-200624003-00002
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DOI: https://doi.org/10.2165/00019053-200624003-00002