Dormuth Colin R, Maclure Malcolm, Glynn Robert J, Neumann Peter, Brookhart Alan M, Schneeweiss Sebastian
Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
Clin Ther. 2008;30 Spec No(Spec No):1038-50. doi: 10.1016/j.clinthera.2008.06.003.
Rapid growth in prescription drug costs has compelled insurers to require increased patient cost-sharing.
The aim of this study was to compare the effects of 2 recent cost-sharing policies on emergency hospitalizations due to chronic obstructive pulmonary disease, asthma, or emphysema (CAE), and on physician visits.
We analyzed data from a large-scale natural experiment in British Columbia (BC), Canada. The cost-sharing policies were a fixed copayment policy (fixed copay policy) and an income-based deductible (IBD) policy with 25% coinsurance (IBD policy). Prescription, physician billing, and hospitalization records were obtained from the BC Ministry of Health. From the total population of BC residents > or = 65 years of age, we extracted data from all patients dispensed an inhaled corticosteroid, beta(2)-agonist, or anticholinergic from June 30, 1997, to April 30, 2004. Poisson regression was used to evaluate the impact of the policies in a cohort of patients receiving long-term inhaler treatment. An identically defined historical control group unaffected by the policy changes was used for comparison.
The study population included 37,320 users of long-term inhaled medications from the BC population of 576,000 persons > or = 65 years of age. During the IBD period but not the fixed copay period, emergency hospitalizations for CAE increased 41% (95% CI for adjusted rate ratio [RR], 1.24-1.60) in patients > or = 65 years of age. There was also a significant increase in physician visits of 3% (95% CI for adjusted RR, 1.01-1.05). No significant increases were observed during the fixed copay period. In a secondary analysis using a concurrent control group, we estimated a smaller but significant increase in emergency CAE hospitalizations of 29% (95% CI for adjusted RR, 1.09-1.52). This analysis also showed increases in physician visits (fixed copay period RR, 1.03 [95% CI for adjusted RR, 1.01-1.05]; IBD period RR, 1.07 [95% CI for adjusted RR, 1.05-1.08]).
The results suggest that the IBD policy was likely associated with an increased risk for emergency hospitalization and physician visits in these users of inhaled medications who were aged > or = 65 years.
处方药费用的快速增长迫使保险公司要求患者增加费用分担。
本研究的目的是比较最近两项费用分担政策对慢性阻塞性肺疾病、哮喘或肺气肿（CAE）导致的急诊住院以及门诊就诊的影响。
我们分析了加拿大不列颠哥伦比亚省（BC）一项大规模自然实验的数据。费用分担政策包括固定自付政策（固定自付政策）和基于收入的免赔额（IBD）政策及25%的共付保险（IBD政策）。处方、医生计费和住院记录来自BC省卫生部。从BC省65岁及以上居民的总人口中，我们提取了1997年6月30日至2004年4月30日期间所有使用吸入性皮质类固醇、β2激动剂或抗胆碱能药物的患者的数据。采用泊松回归评估这些政策对接受长期吸入器治疗患者队列的影响。使用一个不受政策变化影响的相同定义的历史对照组进行比较。
研究人群包括BC省57.6万65岁及以上人口中的37320名长期吸入药物使用者。在IBD期间而非固定自付期间，65岁及以上患者因CAE导致的急诊住院增加了41%（调整率比[RR]的95%置信区间为1.24 - 1.60）。门诊就诊也显著增加了3%（调整RR的95%置信区间为1.01 - 1.05）。在固定自付期间未观察到显著增加。在使用同期对照组的二次分析中，我们估计因CAE导致的急诊住院增加幅度较小但显著，为29%（调整RR的95%置信区间为1.09 - 1.52）。该分析还显示门诊就诊有所增加（固定自付期间RR为1.03[调整RR的95%置信区间为1.01 - 1.05]；IBD期间RR为1.07[调整RR的95%置信区间为1.05 - 1.08]）。
结果表明，IBD政策可能与这些65岁及以上吸入药物使用者急诊住院和门诊就诊风险增加有关。
