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Health Services Research & Development

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2008 HSR&D National Meeting Abstract

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National Meeting 2008

1042 — Drug Costs and Utilization in VHA Nursing Homes: A National Overview of Long-Stay Residents

French DD (VISN-8 Patient Safety Center of Inquiry, James A. Haley Tampa VAMC), Campbell RR (VISN-8 Patient Safety Center of Inquiry, James A Haley Tampa VAMC), Spehar AM (VISN-8 Patient Safety Center of Inquiry, James A Haley Tampa VAMC), Rubenstein LZ (UCLA David Geffen School of Medicine, VA Greater Los Angeles Healthcare System), Cunningham FE (VHA Center for Medication Safety, Pharmacy Benefits Management, and the University of Illinois at Chicago )

Objectives:
The aim of this study was to provide national annualized estimates of drug costs and utilization by drug classes for long-stay nursing home (NH) residents.

Methods:
Our study population consisted of 6,554 VHA long-stay NH residents, identified from the Minimum Data Set (MDS), who had an annual assessment during FY 2005 linked with their 8,847,561 inpatient pharmacy claims. Descriptive statistics of the annual drug costs and utilization by VHA therapeutic drug classes obtained from FY 2005 national pharmacy claims linked at the individual resident level.

Results:
The total cost of the drugs was $23,782,717 in 326 drug classes for 6,554 VHA NH residents. Average annual drug cost was $3,629 per resident [99% Confidence Interval (CI), $3,343-$3,915]. The top 20 drug classes accounted for nearly 70% of total drug costs for long stay NH residents. Approximately three-quarters (73.2%) of these residents received a non-opioid analgesic (e.g., acetaminophen, aspirin). Over half of these residents received antidepressants (SSRIs) (54.2%), or other anti-infective drugs (e.g., bacitracin, ciprofloxacin) (53.3%).

Implications:
This is the first national study of drug costs and utilization for long-stay veterans in VHA nursing homes. It is essential in any study analyzing drug costs and utilization in nursing home patients to differentiate long-stay residents from short-stay patients. Our findings underscored that a relatively short list of drugs account for a large proportion of the drug costs for the long-stay residents.

Impacts:
This kind of detailed cost and utilization analysis has implications for projecting future costs associated with the Medicare Part D prescription benefit for dually eligible nursing home residents.


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