Neumann Peter J, Lin Pei-Jung, Greenberg Dan, Berger Marc, Teutsch Steven, Mansley Edward, Weinstein Milton C, Rosen Allison B
Department of Health Policy and Management and Center for Risk Analysis, Harvard School of Public Health, Boston, MA 02115, USA.
Am J Manag Care. 2006 Jan;12(1):30-6.
To investigate the extent to which preferred drug lists and tiered formularies reflect evidence of value, as measured in published cost-utility analyses (CUAs).
Using 1998-2001 data from a large registry of cost-effectiveness analyses, we examined the 2004 Florida Medicaid preferred drug list and the 2004 Harvard Pilgrim Pharmacy Program 3-tier formulary, and compared cost-utility ratios (standardized to 2002 US dollars) of drugs with preferred and nonpreferred status.
Few drugs on the formularies had any cost-utility data available. Of those that did, median cost-utility ratios were somewhat higher (less favorable) for Florida's preferred drugs compared with the nonpreferred drugs (25,465 dollars vs 13,085 dollars; P = .09). Ratios did not differ for drugs on tiers 1 and 2 of the Harvard Pilgrim formulary, although they were higher for tier 3 and for excluded drugs (18,309 dollars, 18,846 dollars, 52,119 dollars, and 22,580 dollars, respectively; P = .01). Among therapies reported to be cost-saving or to have cost-utility ratios below 50,000 dollars, 77% had favored status in Florida Medicaid and 73% in Harvard Pilgrim. Among dominated drug interventions (reported to be more costly and less effective than alternatives), 95% had favored status in Florida Medicaid and 56% in Harvard Pilgrim.
This study underscores the paucity of published cost-utility data available to formulary committees. Some discrepancies prevail between the value of drugs, as reflected in published cost-utility ratios, and the formulary placement policies of 2 large health plans.
通过已发表的成本效用分析（CUA）来研究优先药物清单和分层处方集在多大程度上反映了价值证据。
利用1998 - 2001年来自大型成本效益分析登记处的数据，我们研究了2004年佛罗里达医疗补助优先药物清单和2004年哈佛朝圣者药房计划的三层处方集，并比较了具有优先和非优先地位药物的成本效用比（标准化为2002年美元）。
处方集中很少有药物有可用的成本效用数据。在那些有数据的药物中，佛罗里达优先药物的中位成本效用比与非优先药物相比略高（更不理想）（25,465美元对13,085美元；P = 0.09）。哈佛朝圣者处方集第1层和第2层的药物比率没有差异，尽管第3层和排除药物的比率更高（分别为18,309美元、18,846美元、52,119美元和22,580美元；P = 0.01）。在报告为节省成本或成本效用比低于50,000美元的治疗方法中，77%在佛罗里达医疗补助中有优先地位，73%在哈佛朝圣者中有优先地位。在占优药物干预措施（报告比替代方案成本更高且效果更差）中，95%在佛罗里达医疗补助中有优先地位，56%在哈佛朝圣者中有优先地位。
本研究强调了可供处方集委员会使用的已发表成本效用数据的匮乏。已发表的成本效用比所反映的药物价值与两个大型健康计划的处方集安排政策之间存在一些差异。
