Comparative effectiveness research in practice: the Drug Effectiveness Review Project experience

Area of Science:

• Health Services Research
• Pharmacoeconomics
• Clinical Practice Guidelines

Background:

• Comparative effectiveness research (CER) aims to inform healthcare decisions.
• Medicaid programs face challenges in translating research findings into practice.
• Preferred drug lists (PDLs) are formulary tools used to manage prescription drug costs and utilization.

Purpose of the Study:

• To evaluate the impact of the Drug Effectiveness Review Project (DERP) findings on prescribing behavior.
• To assess the combined effect of DERP findings and Medicaid PDLs on ACE inhibitor prescribing.
• To determine the effectiveness of CER dissemination strategies in influencing clinical practice.

Main Methods:

• Analysis of 2001-2008 Medicaid prescription drug claims and enrollment data from 17 states.
• Utilized a Wilcoxon signed rank test to compare ACE inhibitor prescribing before and after DERP report release and PDL implementation.
• Primary outcome: percentage of 'differentiated' ACE inhibitor prescriptions, as defined by DERP.

Main Results:

• Significant increase in the utilization of differentiated ACE inhibitors in states that implemented both DERP and a PDL (p < 0.05).
• No significant changes in ACE inhibitor utilization observed in states that did not participate in DERP or did not implement a PDL.
• The combination of DERP participation and PDL implementation was associated with increased use of higher-quality ACE inhibitors.

Conclusions:

• While CER findings alone may not alter prescribing habits, PDLs can align drug utilization with clinical evidence.
• The integration of DERP findings with Medicaid PDLs provides an effective strategy for translating CER into clinical practice.
• This combined approach enhances the adoption of higher-quality medications within state Medicaid programs.