Introduction: From 1997 to 2001, spending on psychiatric medications grew by over 20 percent annually, according to the Substance Abuse and Mental Health Services (SAMHSA) Spending Estimates. Psychiatric medications grew from comprising... more
Introduction: From 1997 to 2001, spending on psychiatric medications grew by over 20 percent annually, according to the Substance Abuse and Mental Health Services (SAMHSA) Spending Estimates. Psychiatric medications grew from comprising 11% of all mental health spending in 1996 to 25% in 2002. This growth was driven in large part by the entry of new antipsychotic and antidepressant medications
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Estimate the productivity-related cost of depression in an employed population. By using administrative data, annual short-term disability (STD) and absenteeism costs ($2005) were compared for patients with depression and treated with... more
Estimate the productivity-related cost of depression in an employed population. By using administrative data, annual short-term disability (STD) and absenteeism costs ($2005) were compared for patients with depression and treated with antidepressants and for a matched control group without depression. Mean annual STD costs were $1038 among treated depressed patients versus $325 among controls and $1685 among a subgroup of severely depressed treated patients versus $340 among their controls. After controlling for demographic and employment characteristics, treated patients with depression had STD costs that were $356 higher per patient and those with severe depression had costs that were $861 higher. The marginal impact of treated depression on absenteeism was $377. Even when depressed patients are treated with antidepressants, there are substantial productivity losses. Therapies that can better manage depression may provide opportunities for savings to employers.
Research Interests: Nursing, Depression, Multivariate Analysis, Humans, Absenteeism, and 13 moreUnited States, Female, Male, Depressive Disorder, Efficiency, Middle Aged, Occupational, Adult, Public health systems and services research, Drug Costs, Case Control Studies, Occupational and environmental medicine, and Costs and Cost Analysis
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Approximately 25 million individuals are projected to gain insurance as a result of the Affordable Care Act (ACA). This study estimated the prevalence of behavioral health conditions and their treatment among individuals likely to gain... more
Approximately 25 million individuals are projected to gain insurance as a result of the Affordable Care Act (ACA). This study estimated the prevalence of behavioral health conditions and their treatment among individuals likely to gain coverage. Pooled 2008-2011 National Survey on Drug Use and Health data for adults (ages 18-64) were used. Estimates were created for all adults, current Medicaid beneficiaries, and uninsured adults with incomes that might make them eligible for the Medicaid expansion or tax credits for use in the health insurance marketplace. Individuals who may gain insurance under the ACA had lower rates of serious mental illnesses (5.4%, Medicaid expansion; 4.7%, marketplace) compared with current Medicaid beneficiaries (9.6%). They had higher rates of substance use disorders (13.6%, Medicaid expansion; 14.3%, marketplace) compared with Medicaid recipients (11.9%). There is significant need for behavioral health treatment among individuals who may gain insurance under the ACA.
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Psychotropic drug development is perceived to be lagging behind other pharmaceutical development, even though there is a need for more effective psychotropic medications. This study examined the state of the current psychotropic drug... more
Psychotropic drug development is perceived to be lagging behind other pharmaceutical development, even though there is a need for more effective psychotropic medications. This study examined the state of the current psychotropic drug pipeline and potential barriers to psychotropic drug development. The authors scanned the recent academic and "grey" literature to evaluate psychotropic drug development and to identify experts in the fields of psychiatry and substance use disorder treatment and psychotropic drug development. On the basis of that preliminary research, the authors interviewed six experts and analyzed drugs being studied for treatment of major psychiatric disorders in phase III clinical trials. Interviews and review of clinical trials of drugs in phase III of development confirmed that the psychotropic pipeline is slim and that a majority of the drugs in phase III trials are not very innovative. Among the barriers to development are incentives that encourage firms to focus on incremental innovation rather than take risks on radically new approaches. Other barriers include human brain complexity, failure of animal trials to translate well to human trials, and a drug approval threshold that is perceived as so high that it discourages development. Drivers of innovation in psychotropic drug development largely parallel those for other drugs, yet crucial distinctions have led to slowing psychotropic development after a period of innovation and growth. Various factors have acted to dry up the pipeline for psychotropic drugs, with expert opinion suggesting that in the near term, this trend is likely to continue.
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The authors reviewed studies of Medicaid spending on mental health and substance abuse services. Studies were identified through a search of MEDLINE and bibliographies of known articles on mental health and substance abuse spending and by... more
The authors reviewed studies of Medicaid spending on mental health and substance abuse services. Studies were identified through a search of MEDLINE and bibliographies of known articles on mental health and substance abuse spending and by searching Web sites of or contacting key government and private organizations. Of 448 studies identified, the 14 that included Medicaid expenditure percentages for 1984 or later were compared. The most comprehensive studies of such spending suggest that between 9.3 and 13 percent of all Medicaid dollars are spent on behavioral health services. The most comprehensive estimates came from claims-based studies or studies based on the National Health Accounts. Studies based on provider or consumer surveys missed large portions of Medicaid spending. Policy makers need to ensure that they use the most accurate data to track mental health and substance abuse spending, an important part of total Medicaid expenditures.
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Recessions are associated with increased prevalence of mental and substance use disorders, but their effect on use of behavioral health services is less clear. This study examined changes in spending per enrollee for behavioral health... more
Recessions are associated with increased prevalence of mental and substance use disorders, but their effect on use of behavioral health services is less clear. This study examined changes in spending per enrollee for behavioral health services compared with general medical services among individuals with private insurance following the Great Recession that began in 2007. The National Survey on Drug Use and Health was used to examine the prevalence of behavioral health conditions among persons with private insurance from 2004 to 2013. Truven Health MarketScan Commercial Claims and Encounters data (2004-2012) were used to calculate use of and spending on treatment of behavioral and general medical conditions before and after the recession among individuals with employer-sponsored private health insurance. There was a statistically significant increase in serious psychological distress and episodes of major depression between 2007 and 2010. Between 2004-2009 and 2009-2012, the growth i...
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ABSTRACT
Using transaction records on prescriptions filled at retail pharmacies, we will present recent trends in prescribing by primary care provider (PCPs), psychiatric physicians, and all other specialties for groups of drugs widely recognized... more
Using transaction records on prescriptions filled at retail pharmacies, we will present recent trends in prescribing by primary care provider (PCPs), psychiatric physicians, and all other specialties for groups of drugs widely recognized in the treatment of MH conditions. We find that primary care providers prescribe over half of all mental health drugs, including 6 out of every 10 prescriptions written for antidepressants and for anxiolytic, sedative hypnotics used to treat anxiety and sleep disorders. Drug prescribing for antipsychotics and antimanics primarily prescribed for schizophrenia and bipolar disease continues to be dominated by psychiatrists. However, the growth of managed care and managed behavioral health organizations, availability of drugs with fewer side effects, and direct-to-consumer advertising have pushed more prescribing of MH drugs into the primary care arena, creating opportunities for increased access for consumers and potential challenges in quality of MH t...
Spending on psychotropic medications has grown rapidly in recent decades. Using national data on drug expenditures, patent expirations, future drug development and expert interviews, we project that spending will grow more slowly over the... more
Spending on psychotropic medications has grown rapidly in recent decades. Using national data on drug expenditures, patent expirations, future drug development and expert interviews, we project that spending will grow more slowly over the period 2012-2020. The average annual increase is projected to be just 3.0 % per year, continuing the steady deceleration in recent years. The main drivers of this expected deceleration include slower development of new drugs, upcoming patent expirations which will lower prices, and payers' growing ability to manage utilization and promote generic use. The slowdown will relieve some cost pressures on payers, particularly Medicare and Medicaid.
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Substance use disorders affect 12% of Medicaid beneficiaries. The prescription drug epidemic and growing need for treatment of alcohol and opioid dependence have refocused... more
Substance use disorders affect 12% of Medicaid beneficiaries. The prescription drug epidemic and growing need for treatment of alcohol and opioid dependence have refocused states' attention on their provision of substance use disorder treatment services, including medications. This study characterized how Medicaid programs cover these treatment medications. Data were from 2013 Medicaid pharmacy documents, 2011 and 2012 Medicaid state drug utilization records, and a 2013 American Society of Addiction Medicine survey. Results showed that only 13 state Medicaid programs included all medications approved for alcohol and opioid dependence on their preferred drug lists. The most commonly excluded were extended-release naltrexone (19 programs), acamprosate (19 programs), and methadone (20 programs). For combined buprenorphine-naloxone, 48 Medicaid programs required prior authorization, and 11 programs used 1- to 3-year lifetime treatment limits. Given the chronic nature of substance use disorders and the overwhelming evidence supporting ongoing coverage for many of these medications, states may want to reexamine substance use disorder benefits.
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The study aimed to determine the prevalence of documented side effects and drug–drug interactions in older adults using antidepressants and their implications for adherence. Data were from the MarketScan Medicare Database,which comprises... more
The study aimed to determine the prevalence of documented side effects and drug–drug interactions in older adults using antidepressants and their implications for adherence. Data were from the MarketScan Medicare Database,which comprises insurance claims from retirees with employer-sponsored Medicare supplemental insurance. Subjects were aged 65 years or older, new antidepressant users, and had a depression diagnosis between July 1, 2001, and December 31, 2006.Twelve commonly reported antidepressant side effects were identified in the month after drug initiation through International Classification of Diseases, Ninth Revision,Clinical Modification diagnoses. Potential drug- drug interactions involving an antidepressant and another drug were identified during the 1 year after antidepressant initiation using MicroMedex DRUG-REAX software. Multinomial logistic regression was used to determine the association of side effects and potential interactions with refills rates, switching, and ...
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This article focuses on the implications of a recent study of substance abuse (SA) and mental health treatment expenditures for substance abuse treatment policy. Public and private expenditures for SA treatment are estimated and compared... more
This article focuses on the implications of a recent study of substance abuse (SA) and mental health treatment expenditures for substance abuse treatment policy. Public and private expenditures for SA treatment are estimated and compared with those for mental health and all health care in the period between 1987 and 1997. Estimates of SA treatment expenditures were segregated from the Health Care Financing Administration's National Health Accounts across the ten-year period. Information about use, charges, and payments by provider type, payer, and diagnosis was obtained from numerous nationally representative data sets and large claims databases. Those data were used to estimate SA treatment expenditures in the general service sector. For the specialty sector two specialty facility surveys were used to estimate SA treatment expenditures. Information from the two sectors was combined and reconciled to the National Health Accounts. PRINCIPAL FINDINGS. A dramatic shift in SA expend...
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This study used 1994-1995 administrative data from a large public employer to examine the viability of commercial risk adjustment systems for setting capitation payments to competing behavioral health care "carve-outs". The... more
This study used 1994-1995 administrative data from a large public employer to examine the viability of commercial risk adjustment systems for setting capitation payments to competing behavioral health care "carve-outs". The ability of Hierarchical Condition Categories and Adjusted Diagnostic Groups to predict psychiatric expenditures was improved by controlling separately for psychiatric disability. However, even the best models underpredicted expenditures of patients with psychiatric disability by 15%. Relative to full capitation, "mixed" payment systems and soft capitation reduce the ability of carve-outs to earn disproportionate profits by enrolling healthy patients and avoiding sick ones, yet also diminish incentives for cost containment.
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Spending on mental and substance use disorders will likely grow more slowly than all health spending through 2020. We project that spending on mental and substance use disorders, as a share of all health spending, will fall from... more
Spending on mental and substance use disorders will likely grow more slowly than all health spending through 2020. We project that spending on mental and substance use disorders, as a share of all health spending, will fall from 7.4 percent in 2009 ($172 billion out of $2.3 trillion) to 6.5 percent in 2020 ($281 billion out of $4.3 trillion). This trend is the projected result of reduced spending on mental health drugs because of patent expirations, the low likelihood of innovative drugs entering the market, and a slowdown in spending growth for hospital treatment. By 2020 the expansion of coverage to previously uninsured Americans under the Affordable Care Act (ACA), combined with the projected slowdown in Medicare provider payment rates under the ACA and the Budget Control Act of 2011, are expected to add 2.7 percent to behavioral health spending, compared to spending without these changes.
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Approximately 25 million individuals are projected to gain insurance as a result of the Affordable Care Act (ACA). This study estimated the prevalence of behavioral health conditions and their treatment among individuals likely to gain... more
Approximately 25 million individuals are projected to gain insurance as a result of the Affordable Care Act (ACA). This study estimated the prevalence of behavioral health conditions and their treatment among individuals likely to gain coverage. Pooled 2008-2011 National Survey on Drug Use and Health data for adults (ages 18-64) were used. Estimates were created for all adults, current Medicaid beneficiaries, and uninsured adults with incomes that might make them eligible for the Medicaid expansion or tax credits for use in the health insurance marketplace. Individuals who may gain insurance under the ACA had lower rates of serious mental illnesses (5.4%, Medicaid expansion; 4.7%, marketplace) compared with current Medicaid beneficiaries (9.6%). They had higher rates of substance use disorders (13.6%, Medicaid expansion; 14.3%, marketplace) compared with Medicaid recipients (11.9%). There is significant need for behavioral health treatment among individuals who may gain insurance under the ACA.
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Linkage of US state hospital discharge records to state death certificate records offers the possibility of tracking long-term mortality outcomes across large, diverse patient populations, which may be useful for comparative effective... more
Linkage of US state hospital discharge records to state death certificate records offers the possibility of tracking long-term mortality outcomes across large, diverse patient populations, which may be useful for comparative effective analyses. To demonstrate the value of linking state community hospital discharge data to vital statistics death files for research by conducting a comparative effectiveness analysis. Linked Patient Discharge Data and Vital Statistics Death Files from the California Office of Statewide Health Planning and Development were used to compare survival rates for patients with an elective repair for abdominal aortic aneurysm who received open aneurysm repair (OAR) versus endovascular aneurysm repair (EVAR). The sample consisted of 13,652 hospitalized patients who underwent an OAR or EVAR for abdominal aortic aneurysm between 1 July 2000 and 31 January 2006. Patients were matched using propensity scores (8966 patients in the matched sample). In-hospital, 30-day, 1-year and 5-year mortality rates were compared between the OAR and EVAR populations, before and after propensity score matching. We found a few data anomalies (92 out of 13,652), primarily in patients' sex and date of death. The analysis revealed that in the matched cohort, in-hospital and 30-day postdischarge mortality rates were significantly lower following EVAR than OAR; however, consistent with previous clinical trials, differences in the 1- and 5-year rates were not statistically significant. The study demonstrates that linked US state discharge and mortality data can be a valuable resource for comparative effectiveness analyses. In particular, this approach may be useful when generally available data sets such as Medicare claims data limit the generalizability of findings. Policy-makers and others should consider greater investments in these data.
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Psychotropic drug development is perceived to be lagging behind other pharmaceutical development, even though there is a need for more effective psychotropic medications. This study examined the state of the current psychotropic drug... more
Psychotropic drug development is perceived to be lagging behind other pharmaceutical development, even though there is a need for more effective psychotropic medications. This study examined the state of the current psychotropic drug pipeline and potential barriers to psychotropic drug development. The authors scanned the recent academic and "grey" literature to evaluate psychotropic drug development and to identify experts in the fields of psychiatry and substance use disorder treatment and psychotropic drug development. On the basis of that preliminary research, the authors interviewed six experts and analyzed drugs being studied for treatment of major psychiatric disorders in phase III clinical trials. Interviews and review of clinical trials of drugs in phase III of development confirmed that the psychotropic pipeline is slim and that a majority of the drugs in phase III trials are not very innovative. Among the barriers to development are incentives that encourage firms to focus on incremental innovation rather than take risks on radically new approaches. Other barriers include human brain complexity, failure of animal trials to translate well to human trials, and a drug approval threshold that is perceived as so high that it discourages development. Drivers of innovation in psychotropic drug development largely parallel those for other drugs, yet crucial distinctions have led to slowing psychotropic development after a period of innovation and growth. Various factors have acted to dry up the pipeline for psychotropic drugs, with expert opinion suggesting that in the near term, this trend is likely to continue.
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This study determined spending on mental health treatment in the United States over time by provider and payer relative to all health spending. Estimates were developed to be consistent with the National Health Expenditure Accounts.... more
This study determined spending on mental health treatment in the United States over time by provider and payer relative to all health spending. Estimates were developed to be consistent with the National Health Expenditure Accounts. Numerous public data sources were used. Mental health treatment expenditures grew from $33 billion in 1986 to $100 billion in 2003. In real 2003 dollars, spending per capita on mental health treatment rose from $205 to $345. The average annual nominal total mental health growth rate was 6.7%. In comparison, total health care expenditures increased by 8.0%. As a result of the slower growth rate of mental health expenditures compared with all health spending, mental health fell from 8% of all health expenditures in 1986 to 6% in 2003. Total national health spending increased by approximately $1.175 trillion from 1986 to 2003; of this, 6% is attributed to an increase in mental health spending. The mix of services has changed, with more care being provided through prescription drugs and in outpatient settings and less in inpatient settings. Payer mix has also shifted, with Medicaid taking a more prominent role. Spending on mental health treatment has increased over the past decade, reflecting increases in the number of individuals receiving mental health treatment, particularly prescription drugs and outpatient treatment. Changes in payer and provider mix raise new challenges for ensuring quality and access.
Research Interests: Psychiatry, Mental Health, Psychopathology, Treatment, Public Health, and 12 moreHumans, Hospitalization, United States, Mental Disorders, Mental health services, Medicaid, Health Expenditures, Public health systems and services research, Drug Costs, Psychiatric Services, Psychotropic Drugs, and Insurance Coverage
This study sought to describe the extent to which community hospitals, in a sample of states, are caring for patients with psychiatric disorders in medical-surgical beds (scatter beds) and to compare the characteristics of patients... more
This study sought to describe the extent to which community hospitals, in a sample of states, are caring for patients with psychiatric disorders in medical-surgical beds (scatter beds) and to compare the characteristics of patients treated in scatter beds with those of patients treated in psychiatric units in community hospitals. Information on hospital discharges in 12 states for patients with a principal psychiatric diagnosis was gathered from the Healthcare Cost and Utilization Project State Inpatient Databases. Discharges of patients who were treated in community hospital psychiatric units (N=370,984) were compared with those of patients who were treated in scatter beds (N=26,969). Overall, only 6.8% of discharges were from scatter beds. The rate of total psychiatric discharges per 10,000 total state population ranged from a high of 62.3 in one study state to a low of 9.6 in another. The average rate of scatter bed discharges per 10,000 state population ranged from 1.6 to 5.8, whereas the average rate of psychiatric unit discharges ranged from 7.4 to 58.9. A comparison of discharges of patients treated in scatter beds with discharges of patients treated in psychiatric units indicated that patients in scatter beds were more likely to have somatic conditions and were half as likely to have an accompanying substance use disorder. Discharge codes indicated that almost 40% of patients from scatter beds had a diagnosis of schizophrenia, episodic mood disorder, or depression; about two-thirds were admitted from emergency rooms; and about one-fifth were transferred to another facility. More research is needed to determine the optimal supply of psychiatric unit beds across regions and whether and how scatter beds should be used to address the lack of psychiatric beds.
Research Interests: Mental Health, Treatment, Public Health, Adolescent, Comparative Study, and 16 moreHumans, Child, United States, Female, Male, Young Adult, Infant, Social Environment, Newborn Infant, Aged, Middle Aged, Adult, Public health systems and services research, Psychiatric Services, Psychiatric, and Child preschool
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The authors reviewed studies of Medicaid spending on mental health and substance abuse services. Studies were identified through a search of MEDLINE and bibliographies of known articles on mental health and substance abuse spending and by... more
The authors reviewed studies of Medicaid spending on mental health and substance abuse services. Studies were identified through a search of MEDLINE and bibliographies of known articles on mental health and substance abuse spending and by searching Web sites of or contacting key government and private organizations. Of 448 studies identified, the 14 that included Medicaid expenditure percentages for 1984 or later were compared. The most comprehensive studies of such spending suggest that between 9.3 and 13 percent of all Medicaid dollars are spent on behavioral health services. The most comprehensive estimates came from claims-based studies or studies based on the National Health Accounts. Studies based on provider or consumer surveys missed large portions of Medicaid spending. Policy makers need to ensure that they use the most accurate data to track mental health and substance abuse spending, an important part of total Medicaid expenditures.
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We show that the flash-induced fading effect can be influenced by grouping based on colour and shape similarity. In flash-induced fading, peripherally presented elements perceptually disappear after a flash has been presented around or... more
We show that the flash-induced fading effect can be influenced by grouping based on colour and shape similarity. In flash-induced fading, peripherally presented elements perceptually disappear after a flash has been presented around or next to the element(s) (Kanai and Kamitani, 2003 Journal of Cognitive Neuroscience 15 664-672). In the present study, two elements (which could either be similar or different in both colour and shape) were presented at an eccentricity of 2.6 degrees from a fixation cross. After 2 s, a short flash (40 ms) was presented around one of the elements. The two elements remained on the screen for 2.5 s after the flash. We found a higher percentage of mutual perceptual disappearance when the two elements were similar in colour or in shape. These results converge with other findings showing that perceptual fading phenomena are influenced by effects of perceptual grouping. This indicates that, besides low-level adaptation, more global processes play a part in perceptual fading as well and should thus be taken into account in giving a full explanation of perceptual fading in general.