# Presentation: 153658

## 
The Use of Comparative Effectiveness Research
In Decision Making

~

Gail Shearer
Consumers Union

AHRQ 2007 Annual Conference

September 27, 2007

***The Use of Comparative Effectiveness Research***
***In Decision Making***
***~***
***Gail Shearer***
***Consumers Union***
**AHRQ 2007 Annual Conference**
***September 27, 2007***

**Notes:**
Thank you
This project is all about translating complicated evidence-based medicine findings and disseminating them to the public so that consumers – and doctors and pharmacists – can make decisions based on science and not based on advertising/marketing.
Especially pleased to be here in light of the burden that employers are facing with the increasing costs of health care. 
Also with the increasing need that employers have for unbiased information about health care quality and cost.

## 
Case study: How comparative-effectiveness research can benefit consumers and taxpayers.
What made our project possible: Drug Effectiveness Review Project (OHSU; basis for Medicaid drug decisions by participating states)
Powerful model that can be expanded.

- Case study: How comparative-effectiveness research can benefit consumers and taxpayers.
- What made our project possible: Drug Effectiveness Review Project (OHSU; basis for Medicaid drug decisions by participating states)
- Powerful model that can be expanded.

**Notes:**
Our 18th report – on diabetes – released in July
First report that draws on research from Section 1013 reports under the MMA. Very excited about this.
BBD is all about translating complex evidence-based medicine into terms that consumers can understand ... and then disseminating the findings to as broad an audience as possible.
Similar in many ways to the wonderful work that is going on at AHRQ under Section 1013, and we are very eager to continue to work together.

## About Consumer Reports

Trusted source of objective information since 1936
Accepts no advertising and is independent of all commercial interests including drug companies
Independent
Non-profit

- Trusted source of objective information since 1936
- Accepts no advertising and is independent of all commercial interests including drug companies
- Independent
- Non-profit

**Notes:**
You may be familiar with Consumers Union, publisher of Consumer Reports.
We learned early on in this project that the Consumer Reports brand name went far in helping establish that this information comes from a credible, unbiased source, without ties to the drug industry.
Focus groups: value drugs, best buy drugs

## Mission:
Provide unbiased in-depth information on prescription drugs for consumers and doctors
Increase access and affordability to needed medicines
Relieve financial burden caused by high drug prices

- Provide unbiased in-depth information on prescription drugs for consumers and doctors
- Increase access and affordability to needed medicines
- Relieve financial burden caused by high drug prices

**Notes:**
We have several target audiences including those who lack drug coverage and have large drug expenditures.
We think that our information can be very helpful to employees who have drug coverage but face increasing deductibles and copayments
Can benefit employers and employees who are eager to cut costs while improving quality..
Our feedback to date has convinced us that there is a high demand for this kind of unbiased information from many different directions.

**Notes:**
Our home page
FREE: People find this hard to believe
About to change: we will be integrated into consumerreports.org by the end of the year
Have 19 BBD reports as well as 6 “shopper’s guides” prepared with NLM funding.
All material directed at providing consumers unbiased information to help them – working with providers – make informed choices to improve their health care and save them money.

## Goals for Consumers

Provide them with objective information on effectiveness of prescription drugs 
Help them open a discussion about drug costs with their doctor
Help them afford the medicines they need (copayments, donut, uninsured)

- Provide them with objective information on effectiveness of prescription drugs
- Help them open a discussion about drug costs with their doctor
- Help them afford the medicines they need (copayments, donut, uninsured)

**Notes:**
We stress in all of our reports that consumers should use this information to open a conversation with their doctor
We are building many levels of medical review into the project.
We are working with a very strong advisory board, mostly of doctors, to try to reach out to the medical community as partners.

## 
Identifying CR Best Buy Drugs

Start with credible source of unbiased, rigorous analysis of clinical evidence about drug effectiveness  (DERP)
Intense medical input through consultants, internal CU review, and medical peer review
Selections based on effectiveness, safety record, and price

***Identifying CR Best Buy Drugs***
- Start with credible source of unbiased, rigorous analysis of clinical evidence about drug effectiveness  (DERP)
- Intense medical input through consultants, internal CU review, and medical peer review
- Selections based on effectiveness, safety record, and price

**Notes:**
2001 Legislation in Oregon was key: systematic reviews
Gradually grew into what we now call DERP, which includes 15 states (use for Medicaid drug selection) and 2 private members
Systematic reviews are done by AHRQ funded EPC's, including the EPC at OHSU, RAND, and UNC
We add price information
We have a process of intensive review, including medical peer review by outside experts

## Present Information in Easy to Use Format(back side of 2 page report)

**Notes:**
Make the information accessible to consumers.  
The two page reports which are on line in PDF format, and also available in hard copy from Best Buy Drugs offices in Washington, D.C. – are designed to take the DERP information and present choices in an easy to use format that consumers can take with them to their doctor’s office.

## 
The Statins

Introduction of generics: changing marketplace
Huge stakes: $8 billion for Medicare beneficiaries alone
Major health consequences of greater affordability

***The Statins***
- Introduction of generics: changing marketplace
- Huge stakes: $8 billion for Medicare beneficiaries alone
- Major health consequences of greater affordability

**Notes:**
Statins is the category that is has the most consistently high level of user interest.
It is the category that probably has the largest potential savings, on a national basis, from switching to more cost-effective drugs.
Recent generic availability of Zocor/simvastatin, key factor.
National potential savings huge
Health consequences are huge as well: drug more affordable for more who need them.
Recently released an analysis of the market trends showing the increase in sales of newly available generic statins.
Stakes are high!

## Possible Annual Savings: 5 Categories

Statins				    		$1,300
    (cholesterol)
Proton Pump Inhibitors:   			$2,000
    (acid reflux and ulcers)
NSAIDs 			    			$2,200
    (arthritis and pain)
Anti-depressants					$1,200
Beta Blockers					$1,900
	(high blood pressure)

- Statins				    		$1,300
-     (cholesterol)
- Proton Pump Inhibitors:   			$2,000
-     (acid reflux and ulcers)
- NSAIDs 			    			$2,200
-     (arthritis and pain)
- Anti-depressants					$1,200
- Beta Blockers					$1,900
- 	(high blood pressure)

**Notes:**
Savings in typical drug category range from $1000 to over $2000 ... 
No sacrifice in terms of safety or effectiveness
The power of solid, unbiased information

## Slide 11

**Notes:**
Monthly drug costs in 3 categories: NSAIDs, antidepressants and PPIs. 
Comparing the cost of brand drugs such as celebrex, zoloft, nexium with best buy drugs, ibuprofen, fluoxetine and prilosec OTC
Potential savings, without sacrificing safety or effectiveness are large
Stakes are high: Journal of Managed Care Pharmacy recently estimated that as anation, consumers and third party payers have overspent $4.45 billion over the past 3 years on NSAIDs, when there were therapeutically equivalent, lower-cost therapies available.

## Average Cost Plan

**Average Cost Plan**

**Highest Cost Plan**

**Notes:**
Chart shows alternatives in Sacramento
Large potential savings for Medicare beneficiaries!
In this analysis, we looked at 5 common categories of drugs (e.g. nsaids, statins, CCB, ACE, anti-depressants
In 6 zip codes, compared the total annual costs for 2 sets of drug choices: 1 set used high-priced drugs in each category; 2nd set used BBDrugs.
Potential savings were huge – we found that Medicare beneficiaries could save in range of about $2300 to 5000 by switching to bbd’s
Enough for these people to avoid the doughnut
Enough savings to pay premium – if just one category swtich

## Outreach and Intermediaries

Six states (GA, CA, AZ, MN, MD and PA)
Pharmacists, Doctors, Libraries, Senior groups, Employer and Employee Organizations
Recruit your doctor campaign
Agreement with Medco
Project with WEA Trust
Outreach to doctors through Tarascon

- Six states (GA, CA, AZ, MN, MD and PA)
- Pharmacists, Doctors, Libraries, Senior groups, Employer and Employee Organizations
- Recruit your doctor campaign
- Agreement with Medco
- Project with WEA Trust
- Outreach to doctors through Tarascon

**Notes:**
State effort: different approaches in different states (aging, libraries, pharmacists, doctors)
New effort in PA
11 national partners 
Recruit your doctor: packages to activists in Minnesota
MEDCO... details ...

## Early lessons from our outreach efforts:
Consumers have different needs
Need to work through trusted intermediaries
Importance of trustworthy sources 
Learn more about how to communicate with consumers
Remember those without Internet access

- Consumers have different needs
- Need to work through trusted intermediaries
- Importance of trustworthy sources
- Learn more about how to communicate with consumers
- Remember those without Internet access

**Notes:**
Consumers have different needs (2 pager vs. long version), 20% Spanish downloads
Intermediaries. Doctors (effectiveness); pharmacists (cost); PBMs, health plans
Unbiased and trustworthy. Tell story of doctor: as doctor: minimize side effects; as health plan, minimize cost; as medical group – maximize revenue. Need to understand the players. Need to develop a system that can be trusted, that is transparent.
Communicate with conumers. Side effects? Safety? Cost? Low-literacy
Internet – not all. Magazine format. Educate at various levels.

## Slide 15

**Notes:**
Launched in August 2006
Medco has close to 60 million members
This is a non-exclusive arrangement; no money exchanged
Exciting: consumers see this at the point that they are making a decision whether to renew their prescription: we expect that this will be very effective.

## Slide 16

**Notes:**
Consumer Reports will provide Medco with a customized 2-page drug category summary for display to the member. Consumer Reports best buy drug prices (based on national averages) have been deleted by Consumer Reports. Members will be directed to other tools on Medco.com where they can obtain plan-specific pricing. More detailed analysis is available at Consumer Reports own site, crbestbuydrugs.org. These summaries are updated by Consumer Reports on an on-going basis. 

## WEA Insurance Trust

- 2nd largest health insurer in Wisconsin (non profit, public education employees and families)
- Conducted informational campaign directed to beneficiaries using Proton Pump Inhibitors (PPIs):
- 	-- *sustained increase in market *
*	**share of Prilosec OTC*
*	**-- Individual out-of-pocket *
*	**costs reduced $36,000*
*	**--$455,000 in savings*
*	**to the Trust*

**Notes:**
WEA Insurance Trust approached CRBBD and asked if it could include a copy of BBD 2 page report on PPIs in a mailing to beneficiaries encouraging beneficiaries to consider switching to Prilosec OTC.

WEA Insurance Trust, had placed Prilosec OTC on its formulary and also provided a favorable financial incentive to try it, by lowering the relative co-pay below other PPIs.

Two months after the initial postcard mailing in October 2005, the percent market share for Prilosec OTC increased by 3% points versus all other formulary PPIs. It moved from 13.6% to 16.4%.  The second targeted mailing increased the percent market share of Prilosec OTC by an additional 2.5% points (a 5.5% point market share change in total).   This share continued, dipping only slightly by the end of the measurement period in October 2006 to 18.8% or an overall market share increase of 5.2% increase. 

## Best Buy Drug Reports on Pocket Pharmacopoeia – PDA Reference

**Notes:**
Tarascon Publishing has published the Tarascon Pocket Pharmacopoeia drug reference since 1987.

The PDA version of Tarascon Pocket Pharmacopoeia  will contain references to BBD drug reports and summaries through a non commercial distribution agreement that CU and Tarascon Publishing signed.

Physicians who use this service (approximately 80,000 health care providers) will have access to CRBBD summaries on their hand held computers at the time they prescribe.

**Notes:**
One of lessons from outreach: hard to get right 2-pager into right person’s hands. Needed print material for reference... for libraries, physicians’ offices.
Work is underway on what we call the first annual edition of CRBBD.
We plan to disseminate this widely – with a group sales distribution model aimed at pricing it at a very low cost to allow for the broadest distribution. 
Brochure available...

## Slide 20

**Notes:**
We are partnering with groups in CA, GA, MN, AZ, and MD to try to expand the reach of this work, with a focus on those who do not have access to the Internet
In May, we launched our work in MN at a press conf with the governor.
One of the “tools” we are using in MN is this new poster that will be distributed to doctors’ offices and pharmacies. We are working closely with the MMA in Mn, delighted.

## Change the information model from:

***Change the information model from:***

## To:

***To:***

***unbiased, evidence-based information***

**Notes:**
We are eager to grow our impact
Delighted with the feedback to date. Links from medline plus
Press coverage.
Welcome your ideas about possible intermediaries and organizations that might want to link or disseminate material to their members.
We are still learning about how to best translate EBM for consumers ... and learning about how to disseminate findings broadly in a cost-effective way.
Please send your ideas my way.
Thank you

## Slide 23