Ungar Wendy J, Kozyrskyj Anita, Paterson Michael, Ahmad Fida
Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada.
Arch Pediatr Adolesc Med. 2008 Feb;162(2):104-10. doi: 10.1001/archpediatrics.2007.21.
To examine the effect of cost-sharing on the use of asthma medications in asthmatic children. According to asthma guidelines, children with asthma may require treatment with multiple medications, including controllers and relievers, to achieve optimal control. Although families may be enrolled in drug benefit plans, impediments to access persist in the form of cost-sharing.
Population-based retrospective cohort study of children by analysis of administrative medication insurance claims data.
Ontario, Canada.
A cohort of 17 046 Ontario children with asthma enrolled in private drug plans. Main Exposure We used data on out-of-pocket expenses and reimbursement for medications to classify children as having zero, low (< 20%), or high (> or = 20%) levels of cost-sharing.
We examined use of bronchodilators, inhaled corticosteroids, leukotriene receptor antagonists, oral corticosteroids, and combination agents. Multiple linear and logistic regressions compared medication use between cost-sharing groups, controlling for age and sex.
The annual number of asthma medication claims per child was significantly lower in the high cost-sharing group (6.6) compared with the zero (7.0) and low (7.2) cost-sharing groups (P < .001). Children in the high cost-sharing group were less likely to purchase bronchodilators, inhaled corticosteroids, and leukotriene receptor antagonists compared with the low cost-sharing group (odds ratio, 0.76; 95% confidence interval, 0.67-0.86) and were less likely to purchase dual agents compared with the low cost-sharing group (odds ratio, 0.70; 95% confidence interval, 0.66-0.75).
The cost-sharing level affected the use of asthma medication, with the highest cost-sharing group exhibiting significantly lower use of maintenance medications and newer dual agents.
探讨费用分担对哮喘儿童使用哮喘药物的影响。根据哮喘指南，哮喘儿童可能需要使用多种药物进行治疗，包括控制药物和缓解药物，以实现最佳控制。尽管家庭可能参加了药物福利计划，但费用分担形式的获取障碍仍然存在。
通过分析行政用药保险理赔数据对儿童进行基于人群的回顾性队列研究。
加拿大安大略省。
17046名参加私人药物计划的安大略省哮喘儿童队列。主要暴露因素我们使用自付费用和药物报销数据将儿童分为费用分担水平为零、低（<20%）或高（≥20%）的组。
我们研究了支气管扩张剂、吸入性糖皮质激素、白三烯受体拮抗剂、口服糖皮质激素和复方制剂的使用情况。多元线性回归和逻辑回归比较了费用分担组之间的药物使用情况，并对年龄和性别进行了控制。
高费用分担组儿童每年的哮喘药物理赔次数（6.6次）显著低于零费用分担组（7.0次）和低费用分担组（7.2次）（P<.001）。与低费用分担组相比，高费用分担组儿童购买支气管扩张剂、吸入性糖皮质激素和白三烯受体拮抗剂的可能性较小（优势比，0.76；95%置信区间，0.67-0.86），与低费用分担组相比，购买复方制剂的可能性较小（优势比，0.70；95%置信区间，0.66-0.75）。
费用分担水平影响哮喘药物的使用，费用分担最高的组维持药物和新型复方制剂的使用显著较低。
