Feldman S R, Fleischer A B, Chen G J
Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1071, USA.
Am J Manag Care. 1999 Apr;5(4):457-63.
To determine whether prior authorization of topical tretinoin for acne is in the best interest of health insurers and, if so, to determine the optimal prior authorization age for topical tretinoin.
A retrospective, cross-sectional study of data from the National Ambulatory Medical Care Survey was performed.
We performed a sensitivity analysis using published data on the age distribution for topical tretinoin prescriptions for acne and nonacne indications to estimate the cost of topical tretinoin and the cost of performing prior authorizations as a function of the prior authorization age.
A prior authorization age of 25 for topical tretinoin is not cost effective for health insurers. If prior authorization is required, an age threshold of 35 or older is most cost effective. The total cost of topical tretinoin (the sum of the drug costs plus the prior authorization costs) changes little with changes in the prior authorization age; if the prior authorization age is set too low, total costs increase (because the number of prior authorizations increase).
Prior authorization for topical tretinoin is of no great benefit to insurers. As the prior authorization age decreases, the cost of requiring prior authorization increases. Eliminating prior authorization altogether would result in at most a small increase in costs and would be balanced by the benefits to both patients and physicians.
确定局部用维甲酸治疗痤疮的事先授权是否符合健康保险公司的最佳利益，若符合，则确定局部用维甲酸的最佳事先授权年龄。
对来自国家门诊医疗护理调查的数据进行回顾性横断面研究。
我们利用已发表的关于痤疮和非痤疮适应症局部用维甲酸处方年龄分布的数据进行敏感性分析，以估计局部用维甲酸的成本以及作为事先授权年龄函数的进行事先授权的成本。
局部用维甲酸25岁的事先授权年龄对健康保险公司而言不具有成本效益。如果需要事先授权，35岁及以上的年龄阈值最具成本效益。局部用维甲酸的总成本（药物成本加上事先授权成本之和）随事先授权年龄的变化而变化不大；如果事先授权年龄设定得过低，总成本会增加（因为事先授权的数量增加）。
局部用维甲酸的事先授权对保险公司益处不大。随着事先授权年龄降低，要求事先授权的成本会增加。完全取消事先授权最多只会导致成本小幅增加，并且会被对患者和医生双方的益处所平衡。
