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Related Concept Videos

Pharmacokinetic Models: Comparison and Selection Criterion01:26

Pharmacokinetic Models: Comparison and Selection Criterion

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Physiological and compartmental models are valuable tools used in studying biological systems. These models rely on differential equations to maintain mass balance within the system, ensuring an accurate representation of the dynamic processes at play.
Physiological models take a detailed approach by considering specific molecular processes. They can predict drug distribution, metabolism, and elimination changes, providing a comprehensive understanding of how drugs interact with the body.
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Clearance Models: Noncompartmental Models01:17

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Clearance is a pharmacokinetic parameter traditionally defined by compartment models, signifying the rate at which a drug is expelled from the body. However, a noncompartmental model offers an alternative method for assessing clearance, primarily employing empirical data obtained after administering a single drug dose.
The noncompartmental approach capitalizes on extensive sampling data, correlating the volume of distribution to systemic exposure and the administered dosage. This method enables...
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Parameters Affecting Nonlinear Elimination: Zero-Order Input, First-Order Absorption and Two-Compartment Model01:13

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Drugs administered through various routes can lead to nonlinear elimination, resulting in complex pharmacokinetic behaviors crucial to understanding efficacious drug dosing.
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The three-compartment open model is a pharmacokinetic model used to describe the distribution and elimination of drugs following extravascular administration. It comprises a central compartment representing the plasma and two peripheral compartments. The highly perfused peripheral compartment represents organs and tissues with a rich blood supply, such as the liver, kidneys, and lungs. The scarcely perfused peripheral compartment represents tissues with lower blood supply, such as adipose...
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Mechanistic Models: Overview of Compartment Models01:21

Mechanistic Models: Overview of Compartment Models

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Mechanistic models, a category encompassing both physiological and compartmental modeling, differ from empirical models' approaches to incorporating known factors about the systems being modeled. Empirical models describe data with minimal assumptions, while mechanistic models aim to provide a robust description of available data by specifying assumptions and integrating known factors about the system. Compartmental analysis is a key example of a mechanistic model in pharmacokinetics and...
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Methods of Documentation VI: Case Management Model01:15

Methods of Documentation VI: Case Management Model

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The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
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Related Experiment Video

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Inverse Probability of Treatment Weighting Propensity Score using the Military Health System Data Repository and National Death Index
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Modeling the Effects of Formulary Exclusions: How Many Patients Could Be Affected by a Specific Exclusion?

Anne M Sydor1, Emily Bergin1, Jonathan Kay2

  • 11. Division of Patient-Focused Economic and Policy Research Global Healthy Living Foundation, Upper Nyack, New York, USA.

Journal of Health Economics and Outcomes Research
|March 28, 2024
PubMed
Summary

Pharmacy benefit management formularies often mandate medication substitutions that are not medically equivalent, potentially harming millions of patients. These forced changes can lead to adverse events and treatment discontinuation, impacting patient health outcomes.

Keywords:
formulariesformulary exclusionpatient-centered carepharmacy benefits managementprescription drug policy

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Area of Science:

  • Pharmacoeconomics
  • Health Outcomes Research
  • Clinical Pharmacy

Background:

  • Pharmacy benefit management (PBM) formularies, originally for cost-effectiveness, now prioritize PBM financial gains.
  • A significant portion (55%) of mandated substitutions in a major PBM formulary involve non-equivalent active ingredients or formulations.
  • These substitutions may not offer medical or financial benefits to patients.

Purpose of the Study:

  • To model the impact of excluding novel medications for atrial fibrillation/venous thromboembolism, migraine prevention, and psoriasis.
  • To estimate the number of patients affected by formulary exclusions requiring non-equivalent substitutions.
  • To quantify potential adverse events and treatment discontinuations resulting from these exclusions.

Main Methods:

  • Modeled exclusion of novel agents across three therapeutic areas.
  • Utilized population data, market share of top US formularies, and 2021 prescription data.
  • Estimated adverse events and treatment discontinuation rates based on published literature.

Main Results:

  • Potential adverse events could affect up to 1 million for AFib/VTE, 900,000 for migraine, and 500,000 for psoriasis patients.
  • Treatment discontinuation could affect up to 924,000 for AFib/VTE, 646,000 for migraine, and 138,000 for psoriasis patients.
  • Non-equivalent substitutions are common and have significant patient consequences.

Conclusions:

  • Mandated medication substitutions with non-equivalent treatments are prevalent in current formularies.
  • These practices lead to substantial negative health consequences for hundreds of thousands of patients.
  • Cost-benefit analyses of formulary exclusions must include morbidity and mortality impacts.