1. The Military Health System (MHS) Results
Methods
Data source: The Military Data Repository (MDR)
Sample: All MHS beneficiaries, age 18 – 64, residing in the U.S. with a primary diagnosis of cancer (non-melanoma skin cancer) in fiscal years 2007 through were included. Cancer diagnoses were grouped using categories developed by the Agency for Healthcare Research and Quality. Beneficiaries who use both systems (purchased and direct care) were included in both systems of care.
Statistical analysis: Descriptive, bivariate, trend analyses.
Selected Drug Classes: antidepressants, antipsychotics, barbituates (anxiolytics, sedatives), benzodiazepines (anxiolytic, sedative-hypnotics), anxiolytics, sedatives, hypnotics, antimanic agents
Objective
* Examine type and costs of psychotropic medications prescribed to prostate, breast, lung, and head and neck cancer patients within the Military Health System from fiscal years (FY)
Background
Few studies in the United States have examined the costs of psychotropic medications prescribed to individuals diagnosed with cancer, apart from one study conducted with elderly (age 65+) cancer patients (Zuckerman, Davidoff, Erten, et al., 2014).
Understanding the costs of these medications in the oncology setting is essential for healthcare systems which often have to balance the need for quality, evidenced-based care with fiscal realities.
The use of psychotherapeutics potentially impacts total cancer costs, either borne by health insurers or by patients themselves.
The Military Health System (MHS)
The Defense Health Agency administers the MHS which provides medical, pharmacy, and dental care through a worldwide healthcare plan (TRICARE) to 9.5 million beneficiaries of the uniformed services, retirees, and their families.
MHS has two systems of health care:
Purchased Care – Civilian healthcare providers
* 450,000 network providers
* 3,300 network acute care hospitals
Direct Care - Military treatment facilities (MTF)
* 41 MTFs in U.S., 15 MTFs overseas MTFs; ~360 clinics
* 30% of MTFs are accredited by the American College of
Surgeons Commission on Cancer
Purchased versus Direct Care: Average Annual Cost of Antidepressants Per Person by Cancer Site
Results
* About 75% of all patients with breast, prostate, lung, or head and neck cancer accessed purchased (civilian) care at least once for each year. On average, this represented about 28,000 beneficiaries with breast cancer, 14,000 with prostate cancer, 5,200 with lung cancer, and 4,000 with head and neck cancer.
* The average annual cost of psychotropic medications per person by cancer site for was significantly higher in purchased (civilian) care compared to direct (military) care throughout FY2007 – FY2014; the sole exception was lung cancer in FY2014 when the costs were similar.
* Between FY2008 and FY2011, the reimbursed cost of psychotropic drugs dispensed to beneficiaries with breast, prostate, lung, or head and neck cancer increased 17% then dropped 39% by FY2014 even though the prevalence of cancer remained relatively stable.
Purchased versus Direct Care: Average Annual Cost of Benzodiazepines Per Person by Cancer Site
Purchased versus Direct Care: Average Annual Cost of Anxiolytics, Sedatives, and Hypnotics Per Person by Cancer Site
Conclusion
* The cost of psychotropic medications is related to cancer site, sex, system of care, and fiscal year.
*Significant decreases in cost from FY2011 through FY2014 reflect increased success by DoD to purchase psychotropic drugs at competitive prices directly from pharmaceutical companies for brand name and generic drugs, and changes in formulary designs that encourage use of lower priced, same equivalency, drugs.
Monitoring costs of psychotropic drugs, needs to coincide with increased efforts to screen and treat mood disorders among individuals diagnosed with cancer. This information is useful to healthcare systems, and to non-elderly, adult cancer patients who, unlike DoD beneficiaries, may have limited or no drug reimbursement.
Reference: Zuckerman IH, Davidoff AJ, Erten MZ, et al. Support Care Cancer Aug;22(8):