Grootendorst P V, Dolovich L R, O'Brien B J, Holbrook A M, Levy A R
Department of Clinical Epidemiology and Biostatistics, McMaster University, and Centre for Evaluation of Medicines, St. Joseph's Hospital, Hamilton, Ont.
CMAJ. 2001 Oct 16;165(8):1011-9.
Reference-based pricing limits reimbursement for a group of drugs that are deemed therapeutically equivalent to the cost of the lowest-priced product within that group. We estimated the effect of reference-based pricing of nitrate drugs used for long-term prophylaxis on prescribing of and expenditures on nitrates and other anti-anginal drugs dispensed to senior citizens in British Columbia.
We assessed trends in the monthly volume of prescriptions of anti-anginal drugs and the associated drug ingredient cost paid by the province's publicly funded drug subsidy program, Pharmacare, and by the patients themselves for the period April 1994 to May 1999. Trends in monthly rates of nitrate expenditures per 100,000 senior citizens before the introduction of reference-based pricing were extrapolated to infer what expenditures would have been without the policy.
During the 3 1/2 years after reference-based pricing was introduced, Pharmacare expenditures on nitrates prescribed to senior citizens declined by $14.9 million (95% confidence interval $10.7 to $19.1 million). Most of these savings were due to the lower prices that Pharmacare paid for sustained-release nitroglycerin tablets and the nitroglycerin patch, which were the 2 most frequently prescribed nitrates before the introduction of reference-based pricing; $1.2 million (8%) of the savings represented expenditures by senior citizens who purchased drugs that were only partially reimbursed. There were no compensatory increases in expenditures for other anti-anginal drugs. Use of sublingual nitroglycerin--a marker for deteriorating health in patients with angina--did not increase after the introduction of reference-based pricing. The nitroglycerin patch is now the most frequently prescribed nitrate, owing to the fact that Pharmacare resumed the provision of full subsidies for the drug after its manufacturers voluntarily reduced retail prices.
Evidence to date suggests that reference-based pricing of nitrates has achieved its primary goal of reducing drug expenditures. The effects of this policy on patient health, associated health care costs and administrative costs remain to be investigated.
基于参考价格的报销政策限制了一组被认为治疗等效的药物的报销额度，报销额度以该组中价格最低的产品成本为基准。我们评估了用于长期预防的硝酸盐类药物基于参考价格的定价政策对不列颠哥伦比亚省老年人所使用的硝酸盐类药物及其他抗心绞痛药物的处方开具情况和支出的影响。
我们评估了1994年4月至1999年5月期间抗心绞痛药物的月处方量趋势，以及该省公共资助的药物补贴计划“药物护理计划”（Pharmacare）和患者自身支付的相关药物成分成本。在引入基于参考价格的定价政策之前，每10万名老年人中硝酸盐类药物的月支出率趋势被外推，以推断若无该政策支出情况会是怎样。
在引入基于参考价格的定价政策后的3年半时间里，药物护理计划用于老年人硝酸盐类药物的支出减少了1490万美元（95%置信区间为1070万至1910万美元）。这些节省的大部分是由于药物护理计划为缓释硝酸甘油片和硝酸甘油贴片支付的价格降低，这两种药物在引入基于参考价格的定价政策之前是最常开具处方的两种硝酸盐类药物；节省的120万美元（8%）代表老年人购买仅部分报销药物的支出。其他抗心绞痛药物的支出没有出现补偿性增加。引入基于参考价格的定价政策后，作为心绞痛患者健康状况恶化指标的舌下硝酸甘油的使用量并未增加。由于制造商自愿降低零售价格后，药物护理计划恢复了对该药物的全额补贴，硝酸甘油贴片现在是最常开具处方的硝酸盐类药物。
迄今为止的证据表明，硝酸盐类药物基于参考价格的定价政策实现了降低药物支出的主要目标。该政策对患者健康、相关医疗保健成本和行政成本的影响仍有待研究。
