Shireman Theresa I, Rigler Sally K, Jachna Carolyn M, Griebling Tomas L, Eng Marty L
Pharmacy Practice Department, School of Pharmacy, University of Kansas, Kansas City, Kansas 66045, USA.
J Am Geriatr Soc. 2005 Aug;53(8):1366-73. doi: 10.1111/j.1532-5415.2005.53419.x.
State Medicaid programs struggle with rapidly increasing expenditures for pharmaceuticals, and Medicare will likely face the same challenge. This article demonstrates how the adoption of newer drugs across diverse therapeutic classes contributed to one state's Medicaid expenditures over a 3-year period.
Retrospective analysis of administrative claims data.
Older Kansas Medicaid community dwellers and institutionalized beneficiaries.
A 15% random sample (N = 6,256) of recipients aged 60 and older.
Prescription medication use was tracked for three sequential 1-year periods for eight therapeutic classes accounting for the greatest Medicaid drug expenditures, categorizing individual medications as newer or older agents based on generic availability and other clinical distinctions. Outcome measures were utilization per person-year, price per prescription, market share as percentage of prescriptions, and market share as percentage of expenditures for prescriptions within each class.
Use increased for all classes, driven by the adoption of newer agents. Mean prescription prices rose in nearly all classes primarily because of the higher prices of the newer agents. Newer drugs accounted for more than 50% of prescriptions in four of eight classes and constituted a disproportionately greater share of expenditures than their prescription share among several classes: antidepressants (>95%), antipsychotics (>92%), antiulcer agents (>63%), antiinflammatory drugs (>60%), and opiates (>45%).
Newer drug products for a variety of treatment indications consume a majority of pharmaceutical expenditures through widespread adoption and higher prices. Although these agents may offer some therapeutic advantages, further research is needed to determine in what circumstances, and for which patients, the advantages of new pharmaceuticals outweigh their higher costs.
各州的医疗补助计划都在努力应对药品支出的快速增长，医疗保险可能也将面临同样的挑战。本文展示了在三年时间里，不同治疗类别中新型药物的使用是如何导致一个州的医疗补助支出增加的。
对行政索赔数据进行回顾性分析。
堪萨斯州年龄较大的医疗补助社区居民和机构化受益人。
60岁及以上受益人的15%随机样本（N = 6256）。
对占医疗补助药品支出最大比例的八个治疗类别，连续三个1年期追踪处方药的使用情况，根据通用名可用性和其他临床差异将每种药物分类为新型或旧型药物。结果指标包括每人每年的用药量、每张处方的价格、各治疗类别中按处方数计算的市场份额以及按处方支出计算的市场份额。
由于新型药物的使用，所有类别药物的使用量均有所增加。几乎所有类别的平均处方价格都有所上涨，主要原因是新型药物价格更高。新型药物在八个类别中的四个类别中占处方数的50%以上，并且在几个类别中，其支出份额与其处方份额相比不成比例地更大：抗抑郁药（>95%）、抗精神病药（>92%）、抗溃疡药（>63%）、抗炎药（>60%）和阿片类药物（>45%）。
用于各种治疗适应症的新型药品通过广泛使用和更高的价格消耗了大部分药品支出。尽管这些药物可能具有一些治疗优势，但仍需要进一步研究以确定在何种情况下以及针对哪些患者，新型药物的优势超过其更高的成本。
