Systematic Reviews of Drugs Within Classes: Bringing Clinical Evidence to State Policy Makers

1
Systematic Reviewsof Drugs Within
ClassesBringing Clinical Evidence to State
Policy Makers

• NAMI 2005 Annual Convention
• June 20, 2005
• Austin, Texas

2
Oregon Experience

• 60 Increase in drug spending
• Faltering state revenues
• PDL Legislation
• Consider effectiveness first
• Consider cost if effectiveness equal
• Mental Health drugs not included
• Collaboration with OHSU EPC
• Washington and Idaho join
• Approach requires broader base

3
Drug Effectiveness Review Project

• Self-governing collaboration of organizations
  that
• Obtain and synthesize global evidence on the
  relative effectiveness of drugs.
• Support policy makers in using the evidence to
  inform policy in local decision making.

4
Overview of Project
5
Currently AnnouncedParticipating Organizations

• Alaska
• Arkansas
• California
• Oregon
• Washington
• Idaho
• Wyoming
• Kansas

• Michigan
• Missouri
• Minnesota
• North Carolina
• Wisconsin
• CHCF/CALPERS
• CCOHTA

6
Systematic ReviewsComparing Effectiveness of
Drugs Within Classes

• Key questions
• Inclusion/exclusion criteria
• Global data search
• Evaluation of data quality
• Synthesis of good quality data
• Draft report and peer/public review
• Final report
• Presentation to participants
• PowerPoint
• Executive Summary
• Full text report

7
Template Key Questions

• What is the comparative efficacy of different
  (name drug class) in improving (name the outcome
  desired) for (name type of patients by symptoms,
  disease etc.)?
• What are the comparative incidence and nature of
  complications (serious or life threatening, or
  those that may adversely affect compliance of
  different (name the drug class)) for patients
  being treated for (name the type of patients by
  symptoms, disease, etc.)?
• Are there subgroups of patients based on
  demographics (age, racial/ethnic groups, gender),
  other medications or co-morbidities (obesity for
  example) for which one or more medications or
  preparations are more effective or associated
  with fewer adverse effects?

8
Drug Company Interaction

• One day informational conference
• Dossier Submission
• Evidence relevant to key questions
• No economic data
• Center is industry contact
• Public Comment Period
• Full disclosure policy

9
Interaction with the Public, Advocates, and
Medical Community

• Drafts of key questions
• Directly to the Center Evidence-based Policy
• Through local processes of participants
• Draft report public comments
• Draft report peer review comments (AHRQ model)
• Local decision-making processes

10
Four Major Types of Results

• Good evidence, no difference (PPIs)
• Good evidence marginal difference (Triptans)
• Good evidence significant difference (Beta
  Blockers)
• No good evidence (Opiod analgesics)

11
Classes Reviewed

• Proton Pump Inhibitors - PPIs
• Long-acting Opioids
• Statins
• Non-steroidal Anti-Inflammatory Drugs - NSAIDs
• Estrogens
• Triptans
• Skeletal Muscle Relaxants - SMRs
• Oral Hypoglycemics - OHs
• Urinary Incontinence, Drugs to treat - UI
• ACE Inhibitors ACE-I
• Beta Blockers - BB
• Calcium Channel Blockers - CCBs

13. Angiotensin II Receptor Antagonists -
ARBs 14. 2nd Generation Antidepressants 15. Antiep
ileptic Drugs in Bipolar Mood Disorder and
Neuropathic Pain 16. 2nd Generation
Antihistamines 17. Atypical Antipsychotics -
AAP 18. Inhaled Corticosteroids - ICS 19. ADHD
and ADD, Drugs to treat 20. Alzheimers, Drugs to
treat 21. Anti-platelet Drugs 22. Thiazolidinedion
e - TZDs 23. 5HT3 Receptor Antagonists 24. Sedativ
e Hypnotics 25. Targeted Immune Modulators
12
Use by Participants

• Provider/prescriber/consumer education (NC, CHCF)
• Augment PT Committee Information with thorough
  and transparent reports (AK, MI, WI, MN, MO)
• Primary PT Committee Information base (WA, WY,
  OR, ID, KS)
• States all have public disclosure and hearings
• Support to other levels of government (CCOHTA)

13
Participant Use of Mental Health Reports

• 2nd Generation Antidepressants
• Multiple available
• Grandfathering of stable patients
• Atypical Antipsychotics
• No use in PDLs
• Scope expanded due to peer review and public
  feedback
• Observational studies
• Inpatient studies
• Anti-epileptic Drugs in Bipolar disorder
• Alzheimers Treatments
• ADHD/ADD Treatments (final report due 9/05)
• Newer Sedative Hypnotics (final report due 11/05)

14
Contact Information
www.ohsu.edu/policycenter