APPENDIX C

Additional Cost Information

This appendix contains additional graphs that are relevant to the analysis of the potential cost effects associated with the National Formulary (see chapter 3 for discussion).



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DESCRIPTION AND ANALYSIS OF THE VA National Formulary APPENDIX C Additional Cost Information This appendix contains additional graphs that are relevant to the analysis of the potential cost effects associated with the National Formulary (see chapter 3 for discussion).

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DESCRIPTION AND ANALYSIS OF THE VA National Formulary FIGURE C.1 National formulary policy has no effect on market share distribution of antiemetics (open class).

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DESCRIPTION AND ANALYSIS OF THE VA National Formulary FIGURE C.2 Atypical antipsychotics—open class: Market share of pharmaceuticals within the class.

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DESCRIPTION AND ANALYSIS OF THE VA National Formulary FIGURE C.3 Beta-blockers—open class: Market share of pharmaceuticals within the class. NOTE: Some drug products (timolol, pindolol, nadolol, bisoprol, betaxolol, and acebutolol) had negligible market share and were removed for clarity.

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DESCRIPTION AND ANALYSIS OF THE VA National Formulary FIGURE C.4 Inhaled antiasthma agents—open class: Market share of pharmaceuticals within the class. NOTE: Some drug products (triamcinolone, salmeterol, pirbuterol, nedocromil, montelukast, fluticasone, mometasone, levalbuterol, isoetharine, flunisolide, and epinephrine) had negligible market share and were removed for clarity.

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DESCRIPTION AND ANALYSIS OF THE VA National Formulary FIGURE C.5 Nonsedating antihistamines—open class: Market share of pharmaceuticals within the class.

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DESCRIPTION AND ANALYSIS OF THE VA National Formulary FIGURE C.6 Nonsteroidal anti-inflammatory drugs—open class: Market share of pharmaceuticals within the class. NOTE: Some drug products (tolmetin, phenylbutazone, meclofen, ketoprofen, flurbiprofen, fenoprofen, diflunisal, sulindac, and nabumetone) had negligible market share and were removed for clarity.

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DESCRIPTION AND ANALYSIS OF THE VA National Formulary FIGURE C.7 Oral diabetic—open class: Market share of pharmaceuticals within the class. NOTE: Some drug products (dextrose, diazoxide, tolbutamide, acarbose, troglitazone, rosiglitazone, repaglinide, miglitol, chlorpropamide, glucose, glucagon, acetohexamide, and glimepirode) had negligible market share and were removed for clarity.

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DESCRIPTION AND ANALYSIS OF THE VA National Formulary FIGURE C.8 Selective serotonin-reuptake inhibitors—open class: Market share of pharmaceuticals within class.

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DESCRIPTION AND ANALYSIS OF THE VA National Formulary FIGURE C.9 Average outpatient pharmacy spending per outpatient user by month on antiemetics

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DESCRIPTION AND ANALYSIS OF THE VA National Formulary FIGURE C.10 Average number of prescriptions per outpatient user by month for proton pump inhibitors.

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DESCRIPTION AND ANALYSIS OF THE VA National Formulary FIGURE C.11 Average number of prescriptions per outpatient user by month for hydroxymethylglutaryl coenzyme A reductase inhibitors.

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DESCRIPTION AND ANALYSIS OF THE VA National Formulary FIGURE C.12 Average number of prescriptions per outpatient user by month for histamine2 receptor blockers.

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DESCRIPTION AND ANALYSIS OF THE VA National Formulary FIGURE C.13 Average number of prescriptions per outpatient user by month for calcium channel blockers (CCBs).

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DESCRIPTION AND ANALYSIS OF THE VA National Formulary FIGURE C.14 Average number of prescriptions per outpatient user by month for alpha blockers.

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DESCRIPTION AND ANALYSIS OF THE VA National Formulary FIGURE C.15 Average number of prescriptions per outpatient user by month for angiotensin converting enzyme inhibitors (ACEI).

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DESCRIPTION AND ANALYSIS OF THE VA National Formulary TABLE C.1 Implementation Date of VHA National Contracts Across the VISNs   ACE inhibitors   HMG CoA Ris lovastatin/simvastatin LHRHs goserelin PPIs lansoprazole lisinopril fosinopril H2R blockera famotidine Alpha blockersb terazosin National 06/02/1997 01/13/1997 02/06/1997 10/20/1997 01/12/1998 8/9/1996–8/8/1998 7/1/1997–6/30/1998 VISN 1 06/02/1997 01/13/1997 02/06/1997 10/20/1997 01/12/1998 8/9/1996–8/8/1998 07/01/1997 VISN2 06/02/1997 01/13/1997 02/06/1997 10/20/1997 01/12/1998 8/9/1996–8/8/1998 07/01/1997 VISN3 06/02/1997 01/13/1997 02/06/1997 10/20/1997 01/12/1998 8/9/1996–8/8/1998 07/01/1997 VISN4 06/02/1997 01/13/1997 02/06/1997 10/20/1997 01/12/1998 8/9/1996–8/8/1998 07/01/1997 VISN 5 06/02/1997 01/13/1997 02/06/1997 10/20/1997 01/12/1998 8/9/1996–8/8/1998 07/01/1997 VISN 6 06/22/1997 01/13/1997 02/06/1997 10/20/1997 01/12/1998 8/9/1996–8/8/1998 07/01/1997 VISN7 06/02/1997 01/13/1997 02/06/1997 10/20/1997 01/12/1998 8/9/1996–8/8/1998 07/01/1997 VISN 8 07/02/1997 02/13/1997 03/06/1997 11/20/1997 02/12/1998 9/9/1996–9/8/1998 08/01/1997 VISN 9 06/02/1997 01/13/1997 02/06/1997 10/20/1997 01/12/1998 8/9/1996–8/8/1998 07/01/1997 VISN 10 06/02/1997 01/13/1997 02/06/1997 10/20/1997 01/12/1998 08/09/1996 07/01/1997 VISN 11 06/02/1997 01/13/1997 02/06/1997 10/20/1997 01/12/1998 8/9/1996–8/8/1998 07/01/1997 VISN 12 06/02/1997 01/13/1997 02/06/1997 10/20/1997 01/12/1998 8/9/1996–8/8/1998 07/01/1997 VISN 13 06/02/1997 01/13/1997 02/06/1997 10/20/1997 01/12/1998 8/9/1996–8/8/1998 07/01/1997 VISN 14 06/02/1997 01/13/1997 02/06/1997 10/20/1997 01/12/1998 8/9/1996–8/8/1998 07/01/1997 VISN 15 10/28/1997 06/11/1996 06/11/1996 10/28/1997 06/11/1996 01/02/1997 07/17/1997 VISN 16 06/02/1997 01/13/1997 02/06/1997 10/20/1997 01/12/1998 8/9/1996–8/8/1998 07/01/1997 VISN 17 06/02/1997 01/01/1997 01/01/1997 10/01/1997 12/01/1998 08/09/1996 07/01/1997 VISN 18 06/02/1997 01/13/1997 02/06/1997 10/20/1997 01/12/1998 8/9/1996–8/8/1998 07/01/1997 VISN 19 7/1/1997–9/1/1997 3/1/1997–7/1/1997 3/1/1997–4/1/1997 2/1/1997–12/1/1997 2/1/1997–12/1/1997 9/1/1996–12/1/1996 7/1/1997–10/1/1997 VISN 20 06/01/1997 12/01/1996 05/01/1997 10/20/1997 01/12/1998 8/9/1996–8/8/1998 7/1/1997–6/30/1998 VISN 21 06/02/1997 12/20/1996 01/24/1997 09/19/1997 09/19/1997 07/26/1996 08/15/1998 VISN 22 07/02/1997 02/13/1997 03/06/1997 11/20/1997 05/12/1998 9/9/1996–9/8/1998 08/01/1997 a H2R blockers were closed (8/9/1996) and reclassified as open (8/8/1998). b Alpha-blockers were closed (7/1/1997) and reclassified as preferred (6/30/1998).

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DESCRIPTION AND ANALYSIS OF THE VA National Formulary TABLE C.2 Regression Results on Natural Logarithm of Spending per Veteran Outpatient User Variable ACEI Alpha HMG PPI CCB H2R Closed -0.185 (8.60) -0.193 (9.10) -0.085 (5.92) -0.076 (5.45)   -0.529 (11.26) Subsequent change in formulary status* -0.089 (3.93) -0.195 (4.91)   -0.0605 (7.73) preferred   0.076 (1.83)   % Male -0.007 (1.99) 0.013 (2.69) 0.017 (4.87) 0.041 (12.03) 0.010 (2.20) 0.005 (0.46) %<45 years 0.0001 (0.06) 0.011 (3.33) -0.002 (0.85) 0.003 (1.11) 0.004 (1.32) 0.022 (3.13) % 45–65 0.019 (2.96) -0.001 (0.14) -0.005 (0.79) -0.050 (7.99) -0.020 (2.38) 0.011 (0.63) Time -0.019 (15.27) -0.046 (24.45) 0.036 (29.43) 0.054 (43.48) 0.010 (6.06) 0.014 (3.15) Time2 0.0002 (8.55) -0.0004 (10.86) -0.0002 (10.56) -0.003 (21.11) -0.0002 (8.57) -0.0004 (5.74) Constant 1.203 (3.01) -1.819 (3.39) -0.642 (1.66) -1.941 (5.16) 1.362 (2.71) -0.388 (0.35) VISN fixed-effects included   R2 0.83 0.83 0.92 0.96 0.66 0.66 F 198.43 201.2 507.5 944.3 85.86 80.12 NOTE: ACEI = angiotensin converting enzyme inhibitor; alpha = alpha blocer; CCB = calcium channel blocker; HMG = hydroxymethylglutaryl coenzyme A reductase inhibitor; PPI = proton pump inhibitor; VISN = veteran integrated service network; t statistics in parentheses. * For ACEIs, this variable represents the addition of a second closed drug, fosinopril, to the National Formulary. For alpha blockers, this variable represents the change in formulary status from closed to preferred. For H2R blockers, this variable represents the reopening of the class.

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DESCRIPTION AND ANALYSIS OF THE VA National Formulary TABLE C.3 Regression Results on Natural Logarithm of Inpatient Discharge Rates * Variable ACEI-Related Discharges PPI-Related Discharges Closed -0.014 (0.89) -0.051 (1.54) % Male 0001 (0.26) 0.009 (1.13) %<45 years -0.021 (7.76) -0.125 (2.34) % 45–65 years 0.011 (1.58) 0.006 (0.44) Time -0.081 (10.17) -0.019 (6.15) Time2 -0.00001 (0.85) 0.00004 (0.93) Constant -5.74 (13.53) -6.602 (7.66) VISN fixed-effects included   R2 0.81 0.64 F 183.54 79.00 NOTE: ACEI = angiotensin converting enzyme inhibitor; PPI = proton pump inhibitor, VISN = veteran integrated service network. * The discharge rate is the number of discharges for the selected diagnoses divided by the number of veteran outpatient users. The unit of observation is a VISN-month.