Department of Public Health and Preventive Medicine

Systematic Reviewsof Drugs Within Classes:

Bringing Clinical Evidence to State Policy Makers

NAMI 2005 Annual ConventionJune 20, 2005Austin, Texas

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Dept of PublicHealth andPreventiveMedicine 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

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Dept of PublicHealth andPreventiveMedicineDrug 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.

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Dept of PublicHealth andPreventiveMedicine Overview of Project

STATES & PRIVATE NON PROFITS

CENTER FOR EVIDENCE-BASED POLICY

COORDINATING EVIDENCE BASED PRACTICE CENTER

OREGON EPC UNC EPC EPC RAND

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Dept of PublicHealth andPreventiveMedicine

Currently AnnouncedParticipating Organizations

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

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

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Dept of PublicHealth andPreventiveMedicine

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

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Dept of PublicHealth andPreventiveMedicine Template Key Questions

1. 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.)?

2. 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.)?

3. 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?

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Dept of PublicHealth andPreventiveMedicine 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

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Dept of PublicHealth andPreventiveMedicine

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

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Dept of PublicHealth andPreventiveMedicine Four Major Types of Results

1. Good evidence, no difference (PPI’s)

2. Good evidence marginal difference (Triptans)

3. Good evidence significant difference (Beta Blockers)

4. No good evidence (Opiod analgesics)

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Dept of PublicHealth andPreventiveMedicine Classes Reviewed

1. Proton Pump Inhibitors - PPIs

2. Long-acting Opioids

3. Statins

4. Non-steroidal Anti-Inflammatory Drugs - NSAIDs

5. Estrogens

6. Triptans

7. Skeletal Muscle Relaxants - SMRs

8. Oral Hypoglycemics - OHs

9. Urinary Incontinence, Drugs to treat - UI

10. ACE Inhibitors – ACE-I

11. Beta Blockers - BB

12. Calcium Channel Blockers - CCBs

13. Angiotensin II Receptor Antagonists - ARBs

14. 2nd Generation Antidepressants

15. Antiepileptic 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. Thiazolidinedione - TZDs

23. 5HT3 Receptor Antagonists

24. Sedative Hypnotics

25. Targeted Immune Modulators

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Dept of PublicHealth andPreventiveMedicine Use by Participants

• Provider/prescriber/consumer education (NC, CHCF)

• Augment P&T Committee Information with thorough and transparent reports (AK, MI, WI, MN, MO)

• Primary P&T Committee Information base (WA, WY, OR, ID, KS)

• States all have public disclosure and hearings

• Support to other levels of government (CCOHTA)

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Dept of PublicHealth andPreventiveMedicine

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)

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Dept of PublicHealth andPreventiveMedicine

Contact Information John Kitzhaber, MD, Director503-494-2182

Chair, Governance ProcessRepresents Center to policy-makers and interest

groupsCommunication

Mark Gibson, Deputy Director503-494-2679gibsomar@ohsu.edu

Project Director Project Representative to Participating Organizations

Communication

John Santa, MD, Assistant Director for Health Projects503-494-2691santaj@ohsu.edu

Project Medical DirectorContact to pharmaceutical companies

Project Representative to Participating Organizations

Pam Curtis, MS, Assistant Director for Planning503-494-3094curtispa@ohsu.edu

Project Planning DirectorFacilitator for Governance Process

Process and facilitation issuesProject administration

Susan Daniels, Office Manager503-494-2182danielss@ohsu.edu

Executive Assistant Web Manager

Logistics and operations Project support

www.ohsu.edu/policycenter