Panzer Pat Ellen, Regan Timothy S, Chiao Evelyn, Sarnes Matthew W
Blue Cross Blue Shield of Delaware, Wilmington, DE, USA.
Am J Manag Care. 2005 Oct;11(12 Suppl):S370-9.
As the antidepressant market continues to expand, it is important for healthcare decision makers to develop clinically and economically sound drug benefit designs. As such, the purpose of this study was to determine the economic implications of a generic step therapy (GST) formulary compared with an open formulary for selective serotonin reuptake inhibitors (SSRIs) in patients with anxiety disorders. A model simulating the SSRI treatment patterns of patients diagnosed with an anxiety disorder in a hypothetical health plan with 1 million members was developed. Treatment options were generic SSRI agents (ie, fluoxetine, paroxetine immediate release, and citalopram) and branded SSRI agents (ie, sertraline, paroxetine controlled release, and escitalopram). After treatment initiation, patients could achieve 180 days or more of continuous therapy with no evidence of therapy change, achieve less than 180 days of therapy with no evidence of therapy change, or have a change in therapy. Consequently, patients incurred differential average annual medical and prescription costs. Model probabilities and costs were estimated from published literature and database analyses. The GST formulary resulted in a greater frequency of therapy change than the open formulary (41.3% vs 36.8%) and a lower frequency of continuous therapy for at least 6 months (25.3% vs 29.8%). Costs of SSRI medication were lower for the GST formulary than for the open formulary (11.6 million US dollars vs 14.8 million US dollars ). Medical costs were considerably greater for the GST formulary than for the open formulary, however (178.7 US dollars million vs 174.9 million US dollars, respectively), with a total cost of 190.3 US dollars million for the GST formulary versus 189.6 US dollars million for the open formulary. The incremental cost of implementing a GST formulary over 1 year was 684 360 US dollars , or 0.06 US dollars per member per month. A sensitivity analysis indicated that the model was most sensitive to changes in the cost of SSRI drug therapy and the average annual medical costs for patients with evidence of therapy change. The results of this model indicate that implementing a GST formulary for SSRIs in patients with anxiety disorders may be associated with an increased amount of therapy change and early treatment discontinuation, resulting in an overall cost increase to a health plan.
随着抗抑郁药市场持续扩大，医疗保健决策者制定临床和经济上合理的药物福利设计非常重要。因此，本研究的目的是确定与选择性5-羟色胺再摄取抑制剂（SSRI）开放处方集相比，通用阶梯治疗（GST）处方集对焦虑症患者的经济影响。开发了一个模型，模拟在一个拥有100万会员的假设健康计划中，被诊断患有焦虑症的患者的SSRI治疗模式。治疗选择包括通用SSRI药物（即氟西汀、速释帕罗西汀和西酞普兰）和品牌SSRI药物（即舍曲林、控释帕罗西汀和艾司西酞普兰）。治疗开始后，患者可以实现180天或更长时间的持续治疗且无治疗改变的证据，实现少于180天的治疗且无治疗改变的证据，或者进行治疗改变。因此，患者产生了不同的年均医疗和处方成本。模型概率和成本是根据已发表的文献和数据库分析估计的。GST处方集导致治疗改变的频率高于开放处方集（41.3%对36.8%），至少持续治疗6个月的频率较低（25.3%对29.8%）。GST处方集的SSRI药物成本低于开放处方集（1160万美元对1480万美元）。然而，GST处方集的医疗成本比开放处方集高得多（分别为1.787亿美元对1.749亿美元），GST处方集的总成本为1.903亿美元，而开放处方集为1.896亿美元。实施GST处方集一年的增量成本为684360美元，即每位会员每月0.06美元。敏感性分析表明，该模型对SSRI药物治疗成本的变化以及有治疗改变证据的患者的年均医疗成本变化最为敏感。该模型的结果表明，对焦虑症患者实施SSRI的GST处方集可能与治疗改变增加和早期治疗中断有关，从而导致健康计划的总体成本增加。
