Pharmaceutical Research Databases and Consulting Capabilities

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Transcript Pharmaceutical Research Databases and Consulting Capabilities

Information Assets and Outcomes Research Capabilities at The Medstat Group, Inc.

Ron Ozminkowski, Ph.D.

Director, Health and Productivity Management Research

Agenda

• Medstat is ….

• Thomson Corporation • MarketScan ® Research Databases • Pharmaceutical Research Capabilities • How Do We Get Started?

• What Happens Next?

Medstat is ….

A healthcare information company that:

• Helps customers manage the cost and quality of health services and benefits – Research services – Analytical consulting – Software applications – Databases • Serves all major market segments • Has longest track record in industry (founded 1981) • Employs approximately 750 employees in nine locations • Is part of The Thomson Corporation 3 Copyright 2002 Thomson Medstat

Medstat is Part of the Thomson Corporation

• Global e-information and solutions company with annual revenues of approximately $7.2 billion • Operations organized into four market groups: – Thomson Legal & Regulatory – Thomson Financial (includes First Call) – Thomson Learning – Thomson Scientific & Healthcare • Thomson Scientific • Thomson Healthcare • Medstat 4 Copyright 2002 Thomson Medstat

Medstat Customer Profile

Market Sector

• Pharmaceutical • Employers • State Gov’t • Federal Gov’t • Health Plans • Providers

Customer Overview

Most U.S.-based manufacturers 70+ large employers 20 state programs CMS, AHRQ, CDC, SAMHSA, DOD 100+ health plans 1,000+ hospitals, IDNs, etc.

Three Principal Product Lines

• Decision Support Systems and Solutions – Adding value to internal information by developing databases, applying methods to help understand the data, and developing the tools necessary to organize the data for better decision making.

• Information Solutions – Integrating external market intelligence and applying methods to benchmark, forecast, and analyze for improved decision making.

MarketScan Database Development

Customer Internal Data Eligibility Inpatient claims Outpatient claims Prescription drugs

     

Data Management Process Privacy Protection Integration Standardization Customization Enhancement QA/Improvement Medstat MarketScan Databases

75 million facility and professional claim lines and 40 million drug claims annually

MarketScan

Research Databases

• Large multi-source database of privately insured claim and encounter data – These sources ensure that MarketScan reflects the complexity of the real world of healthcare delivery – Databases represent true continuum of care, including carve outs – 4 million+ annual covered lives • Longitudinal data – Databases support person-level analyses, with three to five years of follow up • The basis of more than 40 peer-reviewed journal articles in the last three years 8 Copyright 2002 Thomson Medstat

How MarketScan Databases Are Built

• Raw data are collected from approximately 100 payers to build individual client databases – Variables standardized – Clinical detail added – Inpatient cases built • Standard variables from individual databases are combined to form the MarketScan Databases – Synthetic patient identifiers assigned, consistent across years – Clinical categories added (e.g., DRGs, DCGs) – Plan type identified (e.g., PPO, POS, comprehensive) – Place, service types, provider types, and industry classifications standardized – MSA and FIPS state-county codes added 9 Copyright 2002 Thomson Medstat

MarketScan Features

• Fully adjudicated claims data • Consistent data definitions • Inpatient and outpatient claims can be linked to enrollment and drug data • Consistent patient identifiers across years, for longitudinal analysis • Linked drug files containing NDC, therapeutic class, copayment, total payment, etc.

MarketScan Database Organization

Standard Files

– Inpatient Admissions File (one record per admission) – Inpatient Services File (one record for each service) – Outpatient Services File – Outpatient Pharmaceutical Claims File – Person-Level Enrollment Files 11 Copyright 2002 Thomson Medstat

Medical Claims: Sample Data Elements

Demographic Clinical

Patient ID Age Gender Employment Class Relationship to Benefic. Geographic Location Industry Admit Date Admit Type Length of Stay DRG Principal Diagnosis Dx2-Dx14 MDC Principal Procedure Proc2-Proc14 Service Date Service Type

Provider

Provider ID Provider Type Place of Service Provider Specialty

Financial

Drug Claims: Sample Data Elements

Demographic

Patient ID Age Gender Employment Class Relationship of Patient to Beneficiary Geographic Location Industry

Drug

National Drug Code Dispense As Written Date Filled Therapeutic Class Therapeutic Group Days Supply Generic Product ID

Provider

Pharmacy ID Pharmacy Class Code

Financial

Commercial Claims and Encounters (CC&E)

• Inpatient and outpatient medical claims linked to drug data, person-level enrollment data, and benefit plan design data • Fee-for-service (FFS) with drug data available since 1992, encounter with drug data available since 1994 • FFS and fully and partially capitated plans represented – Exclusive provider organizations – Preferred provider organizations – Point of service plans – Indemnity plans – Health maintenance organizations 14 Copyright 2002 Thomson Medstat

Commercial Covered Lives

Database/ Year Total Covered Lives* With Drug Data* Commercial Claims and Encounters 1997 1998 1999 2000 2001 4,800,000 4,000,000 3,550,000 3,620,000 3,530,000 1,950,000 (41%) 1,900,000 (48%) 2,620,000 (74%) 2,790,000 (77%) 3,060,000 (87%) With Drug and Enrollment Data* 1,190,000 (25%) 1,580,000 (40%) 2,500,000 (70%) 2,790,000 (77%) 3,060,000 (87%)

Medicare Supplemental and COB

• Inpatient and outpatient Medicare supplemental medical claims linked to drug data, person-level enrollment data, and benefit plan design data • Available since 1995 • Both the employer-paid and Medicare-paid components of care represented 16 Copyright 2002 Thomson Medstat

Medicare Covered Lives

Database/ Year Total Covered Lives* Medicare Supplemental and COB With Drug Data*

1997 1998 1999 2000 2001 590,000 700,000 550,000 540,000 500,000 220,000 (37%) 490,000 (70%) 450,000 (82%) 480,000 (89%) 460,000 (92%)

With Drug and Enrollment Data*

N/A 290,000 (41%) 420,000 (76%) 480,000 (89%) 460,000 (92%) •

Numbers are rounded

MarketScan Databases

• Commercial Claims and Encounters (1992–2002) – 2002 data to be complete in December • MarketScan Early View Data Set (July, 2002 – June, 2003) – A subset of the CCAE data set for 42 large employers • Medicare Supplemental and COB (1995–2002) – Ditto re: 2002 data • Benefit Plan Design (1995–2002) – 2002 data to be complete in January • Health and Productivity Management (1997–2001) – Contains information about illness-related absenteeism, STD, and WC use, linkable to medical and drug claims and enrollment files • Medicaid – three states (1999-2001) – 2 more states to be added soon, with 2002 data 18 Copyright 2002 Thomson Medstat

How Customers Access MarketScan

• Database licensure – Complete database, multiple years – Subset of database, multiple years • Custom reports • Outcomes research studies • Web-based products • Clinical trial recruitment products 19 Copyright 2002 Thomson Medstat

Pharmaceutical Research Capabilities

Pharmaceutical Research Overview

• Total staff of more than 40 – Many with advanced degrees, including • 10 PhDs • 2 MDs – Widely published in peer-reviewed journals – Multiple research disciplines, including economics, health services research, psychology, and statistics • Focus on pharmacoeconomics and clinical effectiveness – Retrospective database studies – Prospective observational studies – Disease management and program evaluations 21 Copyright 2002 Thomson Medstat

Solutions for the Pharmaceutical Marketplace

• Burden of illness • Product differentiation • Market assessment – Pricing strategy – Market sizing – Portfolio selection • Economic protocol design • Decision analytic and budget impact modeling • Clinical trial recruitment 22 Copyright 2002 Thomson Medstat

Methods Often Used in Outcomes Research Studies

• Selection bias adjustments (Heckman, IV) • Decision analytic models • Treatment-effect models • Multivariate techniques – Hazard regression – Linear regression (OLS) – Logit, probit, and propensity score models – Multinomial logit, ordered probit – Latent class analysis – Count models – Duration/time-to-event – Simultaneous equations 23 Copyright 2002 Thomson Medstat

Prospective Studies: The Medstat Advantage

• Assessment of the economic implications of clinical trials • Development of economic protocols for clinical trials • Evaluation of quality of life, productivity, and health status • Support for multi-site clinical and economic studies • Site selection, training, and management 24 Copyright 2002 Thomson Medstat

Sample Prospective Study

• Schizophrenia Care and Assessment Program (SCAP) – Multi-year study of 2,400 people with schizophrenia at six sites – Baseline and repeated assessments of functioning – Detailed medication tracking – Several research themes, including diffusion of new technologies, outcomes, differential treatment, and outcomes by race – Results described in several conference presentations and a few publications 25 Copyright 2002 Thomson Medstat

Clinical Trials Examples

• Depression trial – Used MarketScan data to derive prices for service utilization observed during a clinical trial. Statistical bootstrapping was applied to compare cost effectiveness for alternative measures of effectiveness (responders and remitters) as well as direct and indirect costs.

• Bowel motility trial – Linked hospital discharge and UB-92 data to clinical trial data and found length of stay reductions and subsequent cost savings for study patients.

• Intermittent claudication trial – Assessed the cost-effectiveness of a medication for in the treatment of intermittent claudication (IC).

Decision Analytic and Budget Impact Modeling

• Combine clinical trial efficacy data on patient/drug response with cost information from naturalistic claims data • Estimate real costs based on expected response using age, gender, dose, medication switching • Model impact of proposed drug by entering characteristics of health plan or employer population into software • Econometric modeling programs include those developed for allergic rhinitis, GERD, cholesterol management, and health risk reduction programs 27 Copyright 2002 Thomson Medstat

Clinical Trial Recruitment

• We can locate the best clinical investigators in the best locations • We can find the best patient groups to whom you should advertise • We can tell you the best way to reach them

This means much faster and more effective patient recruitment

Dr. Katz is in a high area (red) for depression office visits.

He has a clear recruiting advantage.

19407 19401

Depression Age 65+: Affective Psychoses Clinical Investigator: Dr. Katz Area: Philadelphia, PA DMA

19001 19009 19116 19075 19462 19031 19405 19038 19046 19406 19444 19115 19095 19399 19428 19150 19027 19333 19028 19014 19087 19073 19063 19037 19065 19052 19015 19086 19152 19012 19138 19126 19119 19008 19085 19010 19041 19003 19083 19026 19035 19128 19141 19144 19120 19127 19072 19004 19140 19129 19066 19096 19082 19050 19151 19132 19133 19134 19131 19121 19122 19125 19139 19143 19130

Dr. Katz

 19102 19123 19106 19146 19147 08102 08103 19064 19018 19142 19145 19148 19023 08104 19111 19124 08105 19149 19137 08110 08108 19135 08109 08107 19070 19043 19081 19033 19074 19032 19079 19078 19094 19022 19029 19113 19153 19112 08063 08093 08030 08059 08099 08106 08035 08007 08033 19136 08065 08045 08002 08086 08049 19013 08078 08029 08083 19114 08077 08052 08034 08066 08096 19017 19118 08084 08027 19154 08003 08043 08026 08075 08057 08097 08021 08061 08014 08020 08090 08051 08056 08032 5 Mile Radius 10 Mile Radius 15 Mile Radius 20 Mile Radius Quintile 1 Quintile 2 Quintile 3 Quintile 4 Quintile 5 Total

Pop 65+

637,230 277,124 116,787 28,810 7,333 1,067,284

Hospital Visits

6,575 2,842 1,186 292 74 10,968

Physician Visits

16,159 6,989 2,931 720 183 26,981

Total Visits

Depression Age 65+: Top Cluster Locations Clinical Investigator: Dr. Katz Area: Philadelphia, PA DMA Inner Cities (green) and Single City Blues (red) are the best PRIZM clusters near Dr. Katz.

These are the perfect targets for direct mail.

 30 5 Mile Radius 10 Mile Radius 15 Mile Radius 20 Mile Radius Copyright 2002 Thomson Medstat Copyright 2002 Claritas/The MEDSTAT Group Single City Blues New Empty Nests Gray Collars Inner Cities Middle America Total

Pop 65+

39,791 57,741 41,722 43,638 42,210 225,102

% Pop

17.68

25.65

18.53

19.39

18.75

100

Depressed Pop 65+

3,975 3,796 3,261 3,195 2,481 16,708

% Pop 65+

10 6.6

7.8

7.3

5.9

7.4

How Do We Get Started?

• Sometimes prospective clients come to us with a question • For example, do patients who use SSRIs for depression cost less than patients who use TCAs?

– The issue is total cost, not just cost of the drug – (Want to know the consequences of drug choice) – Also want to know how it works in real life, not in a clinical trial in this case.

• We talk to the client, then write a proposal – Background on depression and pharmaceutical treatment – Description of study questions and hypotheses to test – Description of data assets that can be used to test those hypotheses – Statistical methods designed to provide most accurate answer to the questions of interest (descriptive and multivariate approaches) – Description of project tasks, timeline, logistics – Pricing – Medstat experience and capabilities – Project staff 31 Copyright 2002 Thomson Medstat

What Happens Then?

• If we are selected to perform the work, a contract is negotiated.

• Then we do the work, and hopefully publish the results in a peer reviewed journal and make conference presentations – In the past, we have done a lot of both.

• When clients are happy, they come back for more, and business thrives.

• If clients are not happy, we try to make them happy.

• But credibility comes first and is never sacrificed.

Market Signals

• The market suggests we are good at what we do.

– Business has grown from about $0.5 million in 1998 to over $5 million this year.

• We recruit good people and often hear compliments about their work.

• We have fun!