苯二氮䓬类药物在医疗保险受益人中的使用情况及支出，以及医疗保险D部分排除条款的影响。
Benzodiazepine use and expenditures for Medicare beneficiaries and the implications of Medicare Part D exclusions.
作者信息
Yang Hui-wen Keri, Simoni-Wastila Linda, Zuckerman Ilene H, Stuart Bruce
机构信息
Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, MD 21201, USA.
出版信息
Psychiatr Serv. 2008 Apr;59(4):384-91. doi: 10.1176/ps.2008.59.4.384.
OBJECTIVES
Benzodiazepines are excluded from prescription drug coverage under Medicare Part D. The objectives of this study were twofold: to provide national estimates of benzodiazepine utilization and expenditure patterns and to examine the impact of drug coverage and other factors associated with utilization of benzodiazepines and potential benzodiazepine substitute classes.
METHODS
The 2002 Medicare Current Beneficiary Survey provided national estimates of benzodiazepine use and expenditures among Medicare beneficiaries. Multivariate logistic regression was conducted to assess the relationships between independent variables and use of benzodiazepines and potential substitute classes. The independent variable of interest was drug coverage, assessed by payer source. Other covariates included in the models were chronic conditions associated with benzodiazepine use, age, sex, race, and income.
RESULTS
In 2002, 13.7% of Medicare beneficiaries received at least one benzodiazepine fill, with an average of 5.8 benzodiazepine prescriptions filled at an annual cost of 190 dollars. Specific sources of prescription drug coverage were not significantly associated with benzodiazepine use. Female gender, chronic mental illness, age under 65, and lower income were significantly positively associated with benzodiazepine use in the Medicare population, whereas black and other races were significantly negatively associated with benzodiazepine use in this population. Compared with Medicare beneficiaries without supplemental drug coverage, beneficiaries with supplemental drug coverage were more likely to use potential benzodiazepine substitute classes than benzodiazepines.
CONCLUSIONS
Benzodiazepines were widely used by Medicare beneficiaries. Drug coverage influences access to benzodiazepines and potential substitute classes. These findings have important implications for identifying beneficiaries potentially affected by the exclusion of benzodiazepine coverage under Medicare Part D.
目的
苯二氮䓬类药物不在医疗保险D部分的处方药覆盖范围内。本研究的目的有两个：提供苯二氮䓬类药物使用情况和支出模式的全国性估计，并研究药物覆盖范围以及与苯二氮䓬类药物使用和潜在苯二氮䓬类替代药物类别相关的其他因素的影响。
方法
2002年医疗保险当前受益人调查提供了医疗保险受益人中苯二氮䓬类药物使用情况和支出的全国性估计。进行多变量逻辑回归以评估自变量与苯二氮䓬类药物及潜在替代药物类别使用之间的关系。感兴趣的自变量是药物覆盖范围，通过付款人来源进行评估。模型中纳入的其他协变量包括与苯二氮䓬类药物使用相关的慢性病、年龄、性别、种族和收入。
结果
2002年，13.7%的医疗保险受益人至少有一次苯二氮䓬类药物配药，平均每年有5.8张苯二氮䓬类药物处方，年费用为190美元。处方药覆盖的具体来源与苯二氮䓬类药物的使用没有显著关联。在医疗保险人群中，女性、慢性精神疾病、65岁以下年龄和低收入与苯二氮䓬类药物的使用呈显著正相关，而黑人和其他种族与该人群中苯二氮䓬类药物的使用呈显著负相关。与没有补充药物覆盖的医疗保险受益人相比，有补充药物覆盖的受益人更有可能使用潜在的苯二氮䓬类替代药物类别而非苯二氮䓬类药物。
结论
医疗保险受益人广泛使用苯二氮䓬类药物。药物覆盖范围影响获得苯二氮䓬类药物和潜在替代药物类别的机会。这些发现对于识别可能受到医疗保险D部分排除苯二氮䓬类药物覆盖影响的受益人具有重要意义。
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