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Suggested Citation: "Appendix C: Additional Cost Information." Institute of Medicine. 2000. Description and Analysis of the VA National Formulary. Washington, DC: The National Academies Press. doi: 10.17226/9879.

APPENDIX C

Additional Cost Information

This appendix contains additional graphs that are relevant to the analysis of the potential cost effects associated with the National Formulary (see chapter 3 for discussion).

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Suggested Citation: "Appendix C: Additional Cost Information." Institute of Medicine. 2000. Description and Analysis of the VA National Formulary. Washington, DC: The National Academies Press. doi: 10.17226/9879.

FIGURE C.1 National formulary policy has no effect on market share distribution of antiemetics (open class).

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Suggested Citation: "Appendix C: Additional Cost Information." Institute of Medicine. 2000. Description and Analysis of the VA National Formulary. Washington, DC: The National Academies Press. doi: 10.17226/9879.

FIGURE C.2 Atypical antipsychotics—open class: Market share of pharmaceuticals within the class.

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Suggested Citation: "Appendix C: Additional Cost Information." Institute of Medicine. 2000. Description and Analysis of the VA National Formulary. Washington, DC: The National Academies Press. doi: 10.17226/9879.

FIGURE C.3 Beta-blockers—open class: Market share of pharmaceuticals within the class. NOTE: Some drug products (timolol, pindolol, nadolol, bisoprol, betaxolol, and acebutolol) had negligible market share and were removed for clarity.

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Suggested Citation: "Appendix C: Additional Cost Information." Institute of Medicine. 2000. Description and Analysis of the VA National Formulary. Washington, DC: The National Academies Press. doi: 10.17226/9879.

FIGURE C.4 Inhaled antiasthma agents—open class: Market share of pharmaceuticals within the class. NOTE: Some drug products (triamcinolone, salmeterol, pirbuterol, nedocromil, montelukast, fluticasone, mometasone, levalbuterol, isoetharine, flunisolide, and epinephrine) had negligible market share and were removed for clarity.

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Suggested Citation: "Appendix C: Additional Cost Information." Institute of Medicine. 2000. Description and Analysis of the VA National Formulary. Washington, DC: The National Academies Press. doi: 10.17226/9879.

FIGURE C.5 Nonsedating antihistamines—open class: Market share of pharmaceuticals within the class.

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Suggested Citation: "Appendix C: Additional Cost Information." Institute of Medicine. 2000. Description and Analysis of the VA National Formulary. Washington, DC: The National Academies Press. doi: 10.17226/9879.

FIGURE C.6 Nonsteroidal anti-inflammatory drugs—open class: Market share of pharmaceuticals within the class. NOTE: Some drug products (tolmetin, phenylbutazone, meclofen, ketoprofen, flurbiprofen, fenoprofen, diflunisal, sulindac, and nabumetone) had negligible market share and were removed for clarity.

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Suggested Citation: "Appendix C: Additional Cost Information." Institute of Medicine. 2000. Description and Analysis of the VA National Formulary. Washington, DC: The National Academies Press. doi: 10.17226/9879.

FIGURE C.7 Oral diabetic—open class: Market share of pharmaceuticals within the class. NOTE: Some drug products (dextrose, diazoxide, tolbutamide, acarbose, troglitazone, rosiglitazone, repaglinide, miglitol, chlorpropamide, glucose, glucagon, acetohexamide, and glimepirode) had negligible market share and were removed for clarity.

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Suggested Citation: "Appendix C: Additional Cost Information." Institute of Medicine. 2000. Description and Analysis of the VA National Formulary. Washington, DC: The National Academies Press. doi: 10.17226/9879.

FIGURE C.8 Selective serotonin-reuptake inhibitors—open class: Market share of pharmaceuticals within class.

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Suggested Citation: "Appendix C: Additional Cost Information." Institute of Medicine. 2000. Description and Analysis of the VA National Formulary. Washington, DC: The National Academies Press. doi: 10.17226/9879.

FIGURE C.9 Average outpatient pharmacy spending per outpatient user by month on antiemetics

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Suggested Citation: "Appendix C: Additional Cost Information." Institute of Medicine. 2000. Description and Analysis of the VA National Formulary. Washington, DC: The National Academies Press. doi: 10.17226/9879.

FIGURE C.10 Average number of prescriptions per outpatient user by month for proton pump inhibitors.

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Suggested Citation: "Appendix C: Additional Cost Information." Institute of Medicine. 2000. Description and Analysis of the VA National Formulary. Washington, DC: The National Academies Press. doi: 10.17226/9879.

FIGURE C.11 Average number of prescriptions per outpatient user by month for hydroxymethylglutaryl coenzyme A reductase inhibitors.

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Suggested Citation: "Appendix C: Additional Cost Information." Institute of Medicine. 2000. Description and Analysis of the VA National Formulary. Washington, DC: The National Academies Press. doi: 10.17226/9879.

FIGURE C.12 Average number of prescriptions per outpatient user by month for histamine₂ receptor blockers.

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Suggested Citation: "Appendix C: Additional Cost Information." Institute of Medicine. 2000. Description and Analysis of the VA National Formulary. Washington, DC: The National Academies Press. doi: 10.17226/9879.

FIGURE C.13 Average number of prescriptions per outpatient user by month for calcium channel blockers (CCBs).

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Suggested Citation: "Appendix C: Additional Cost Information." Institute of Medicine. 2000. Description and Analysis of the VA National Formulary. Washington, DC: The National Academies Press. doi: 10.17226/9879.

FIGURE C.14 Average number of prescriptions per outpatient user by month for alpha blockers.

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Suggested Citation: "Appendix C: Additional Cost Information." Institute of Medicine. 2000. Description and Analysis of the VA National Formulary. Washington, DC: The National Academies Press. doi: 10.17226/9879.

FIGURE C.15 Average number of prescriptions per outpatient user by month for angiotensin converting enzyme inhibitors (ACEI).

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Suggested Citation: "Appendix C: Additional Cost Information." Institute of Medicine. 2000. Description and Analysis of the VA National Formulary. Washington, DC: The National Academies Press. doi: 10.17226/9879.

TABLE C.1 Implementation Date of VHA National Contracts Across the VISNs

				ACE inhibitors
	HMG CoA Ris lovastatin/simvastatin	LHRHs goserelin	PPIs lansoprazole	lisinopril	fosinopril	H₂R blocker^a famotidine	Alpha blockers^b terazosin
National	06/02/1997	01/13/1997	02/06/1997	10/20/1997	01/12/1998	8/9/1996–8/8/1998	7/1/1997–6/30/1998
VISN 1	06/02/1997	01/13/1997	02/06/1997	10/20/1997	01/12/1998	8/9/1996–8/8/1998	07/01/1997
VISN2	06/02/1997	01/13/1997	02/06/1997	10/20/1997	01/12/1998	8/9/1996–8/8/1998	07/01/1997
VISN3	06/02/1997	01/13/1997	02/06/1997	10/20/1997	01/12/1998	8/9/1996–8/8/1998	07/01/1997
VISN4	06/02/1997	01/13/1997	02/06/1997	10/20/1997	01/12/1998	8/9/1996–8/8/1998	07/01/1997
VISN 5	06/02/1997	01/13/1997	02/06/1997	10/20/1997	01/12/1998	8/9/1996–8/8/1998	07/01/1997
VISN 6	06/22/1997	01/13/1997	02/06/1997	10/20/1997	01/12/1998	8/9/1996–8/8/1998	07/01/1997
VISN7	06/02/1997	01/13/1997	02/06/1997	10/20/1997	01/12/1998	8/9/1996–8/8/1998	07/01/1997
VISN 8	07/02/1997	02/13/1997	03/06/1997	11/20/1997	02/12/1998	9/9/1996–9/8/1998	08/01/1997
VISN 9	06/02/1997	01/13/1997	02/06/1997	10/20/1997	01/12/1998	8/9/1996–8/8/1998	07/01/1997
VISN 10	06/02/1997	01/13/1997	02/06/1997	10/20/1997	01/12/1998	08/09/1996	07/01/1997
VISN 11	06/02/1997	01/13/1997	02/06/1997	10/20/1997	01/12/1998	8/9/1996–8/8/1998	07/01/1997
VISN 12	06/02/1997	01/13/1997	02/06/1997	10/20/1997	01/12/1998	8/9/1996–8/8/1998	07/01/1997
VISN 13	06/02/1997	01/13/1997	02/06/1997	10/20/1997	01/12/1998	8/9/1996–8/8/1998	07/01/1997
VISN 14	06/02/1997	01/13/1997	02/06/1997	10/20/1997	01/12/1998	8/9/1996–8/8/1998	07/01/1997
VISN 15	10/28/1997	06/11/1996	06/11/1996	10/28/1997	06/11/1996	01/02/1997	07/17/1997
VISN 16	06/02/1997	01/13/1997	02/06/1997	10/20/1997	01/12/1998	8/9/1996–8/8/1998	07/01/1997
VISN 17	06/02/1997	01/01/1997	01/01/1997	10/01/1997	12/01/1998	08/09/1996	07/01/1997
VISN 18	06/02/1997	01/13/1997	02/06/1997	10/20/1997	01/12/1998	8/9/1996–8/8/1998	07/01/1997
VISN 19	7/1/1997–9/1/1997	3/1/1997–7/1/1997	3/1/1997–4/1/1997	2/1/1997–12/1/1997	2/1/1997–12/1/1997	9/1/1996–12/1/1996	7/1/1997–10/1/1997
VISN 20	06/01/1997	12/01/1996	05/01/1997	10/20/1997	01/12/1998	8/9/1996–8/8/1998	7/1/1997–6/30/1998
VISN 21	06/02/1997	12/20/1996	01/24/1997	09/19/1997	09/19/1997	07/26/1996	08/15/1998
VISN 22	07/02/1997	02/13/1997	03/06/1997	11/20/1997	05/12/1998	9/9/1996–9/8/1998	08/01/1997
^a H₂R blockers were closed (8/9/1996) and reclassified as open (8/8/1998). ^b Alpha-blockers were closed (7/1/1997) and reclassified as preferred (6/30/1998).

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Suggested Citation: "Appendix C: Additional Cost Information." Institute of Medicine. 2000. Description and Analysis of the VA National Formulary. Washington, DC: The National Academies Press. doi: 10.17226/9879.

TABLE C.2 Regression Results on Natural Logarithm of Spending per Veteran Outpatient User

Variable	ACEI	Alpha	HMG	PPI	CCB	H₂R
Closed	-0.185 (8.60)	-0.193 (9.10)	-0.085 (5.92)	-0.076 (5.45)		-0.529 (11.26)
Subsequent change in formulary status*	-0.089 (3.93)	-0.195 (4.91)				-0.0605 (7.73)
preferred					0.076 (1.83)
% Male	-0.007 (1.99)	0.013 (2.69)	0.017 (4.87)	0.041 (12.03)	0.010 (2.20)	0.005 (0.46)
%<45 years	0.0001 (0.06)	0.011 (3.33)	-0.002 (0.85)	0.003 (1.11)	0.004 (1.32)	0.022 (3.13)
% 45–65	0.019 (2.96)	-0.001 (0.14)	-0.005 (0.79)	-0.050 (7.99)	-0.020 (2.38)	0.011 (0.63)
Time	-0.019 (15.27)	-0.046 (24.45)	0.036 (29.43)	0.054 (43.48)	0.010 (6.06)	0.014 (3.15)
Time²	0.0002 (8.55⁾	-0.0004 (10.86)	-0.0002 (10.56)	-0.003 (21.11)	-0.0002 (8.57)	-0.0004 (5.74)
Constant	1.203 (3.01)	-1.819 (3.39)	-0.642 (1.66)	-1.941 (5.16)	1.362 (2.71)	-0.388 (0.35)
VISN fixed-effects included
R²	0.83	0.83	0.92	0.96	0.66	0.66
F	198.43	201.2	507.5	944.3	85.86	80.12
NOTE: ACEI = angiotensin converting enzyme inhibitor; alpha = alpha blocer; CCB = calcium channel blocker; HMG = hydroxymethylglutaryl coenzyme A reductase inhibitor; PPI = proton pump inhibitor; VISN = veteran integrated service network; t statistics in parentheses. * For ACEIs, this variable represents the addition of a second closed drug, fosinopril, to the National Formulary. For alpha blockers, this variable represents the change in formulary status from closed to preferred. For H2R blockers, this variable represents the reopening of the class.

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Suggested Citation: "Appendix C: Additional Cost Information." Institute of Medicine. 2000. Description and Analysis of the VA National Formulary. Washington, DC: The National Academies Press. doi: 10.17226/9879.

TABLE C.3 Regression Results on Natural Logarithm of Inpatient Discharge Rates *

Variable	ACEI-Related Discharges	PPI-Related Discharges
Closed	-0.014 (0.89)	-0.051 (1.54)
% Male	0001 (0.26)	0.009 (1.13)
%<45 years	-0.021 (7.76)	-0.125 (2.34)
% 45–65 years	0.011 (1.58)	0.006 (0.44)
Time	-0.081 (10.17)	-0.019 (6.15)
Time²	-0.00001 (0.85)	0.00004 (0.93)
Constant	-5.74 (13.53)	-6.602 (7.66)
VISN fixed-effects included
R²	0.81	0.64
F	183.54	79.00
NOTE: ACEI = angiotensin converting enzyme inhibitor; PPI = proton pump inhibitor, VISN = veteran integrated service network. * The discharge rate is the number of discharges for the selected diagnoses divided by the number of veteran outpatient users. The unit of observation is a VISN-month.