Hay Joel W, Leahy Michael
Department of Pharmaceutical Economics and Policy, University of Southern California, Los Angeles, CA 90089, USA.
Value Health. 2005 Jul-Aug;8(4):506-16. doi: 10.1111/j.1524-4733.2005.00042.x.
Newer oral allergic rhinitis (AR) medications, the second-generation antihistamines (SGAs) have gained widespread acceptance because of their efficacy and reduced side effects relative to first-generation antihistamines (FGAs). There are no empirical studies comparing the costs of treatment of SGAs relative to FGAs.
We analyzed data from a 20% beneficiary sample (approximately 120,000 continuously enrolled beneficiaries per year) for the Medi-Cal Fee-for-Service program during 1999 to 2000. AR medications available under Medi-Cal included three SGA medications (loratadine, fexofenadine, and cetirizine) and over 200 FGA products containing either diphenhydramine or chlorpheniramine or both. Because multiple medications were evaluated, a sample selection model was estimated using a two-stage multinomial logistic--variance components regression framework.
SGA medications have significantly lower total direct health-care treatment costs per patient than FGA medications with costs ranging from US 347 dollars to US 448 dollars less (P < 0.001), despite higher AR medication costs. Total drug expenditures were also not significantly different for patients using SGA or FGA medications despite SGA prescriptions averaging US 47 dollars higher than FGAs. Emergency department visits, inpatient admissions and physician office visits were also significantly lower for patients using SGA medications.
Significant cost and utilization reductions were associated with all of the SGA medications relative to FGA drugs, despite their higher acquisition costs. If facing higher copayments for prescription AR drugs, many patients, particularly lower income patients, may choose cheaper over-the-counter (OTC) FGAs rather than SGAs. Our analysis finds this might lead to increased overall health-care treatment costs, unless Medicaid and health insurance plans subsidize OTC AR medications.
新一代口服变应性鼻炎（AR）药物，即第二代抗组胺药（SGA），因其疗效优于第一代抗组胺药（FGA）且副作用减少，已获得广泛认可。目前尚无关于SGA与FGA治疗成本比较的实证研究。
我们分析了1999年至2000年期间加利福尼亚医疗救助按服务项目付费计划中20%受益人的数据（每年约120,000名连续参保受益人）。加利福尼亚医疗救助计划涵盖的AR药物包括三种SGA药物（氯雷他定、非索非那定和西替利嗪）以及200多种含有苯海拉明或氯苯那敏或两者皆有的FGA产品。由于评估了多种药物，我们使用两阶段多项逻辑 - 方差成分回归框架估计了样本选择模型。
尽管SGA药物的AR药物成本较高，但每位患者的直接医疗保健总治疗成本显著低于FGA药物，成本低347美元至448美元（P < 0.001）。使用SGA或FGA药物的患者的总药物支出也无显著差异，尽管SGA处方平均比FGA高约计47美元。使用SGA药物的患者的急诊就诊、住院和门诊就诊次数也显著更低。
尽管SGA药物的购置成本较高，但与FGA药物相比，所有SGA药物均能显著降低成本并减少医疗资源利用。如果处方AR药物的自付费用较高，许多患者，尤其是低收入患者，可能会选择更便宜的非处方（OTC）FGA药物而非SGA药物。我们的分析发现，除非医疗补助和医疗保险计划对OTC AR药物进行补贴，否则这可能会导致总体医疗保健治疗成本增加。
