Caetano Patricia A, Raymond Colette B, Morgan Steve, Yan Lixiang
Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC.
Healthc Policy. 2006 Nov;2(2):e154-69.
In May 2003, the government of British Columbia adopted income-based pharmacare, replacing an age-based program. Stated policy goals included the maintenance or enhancement of access to necessary medicines. This study examines the policy impact on access to two widely used drugs for chronic risk factors (antihypertensives and statins).
Data on incident antihypertensive and statin prescriptions between 1997 and 2004 were extracted from PharmaNet. Incident antihypertensive users were those who filled a first prescription after residing in the province for at least two years prior to the initial prescription date. The number of patients who ceased to fill a contiguous series of prescriptions (within 120 days of one another) was used as a measure of apparent discontinuation or interruption of therapy. We used time series analysis to test for changes in incident use and discontinuation.
Between 1997 and 2004, 530,167 BC residents initiated therapy with an antihypertensive, and 264,904 BC residents initiated therapy with a statin. The 2003 policy change had no statistically significant impact on incident use of antihypertensives or statins, when stratified by age or income. Similarly, the 2003 policy did not change the rate of apparent discontinuations of therapy across age and income groups. However, a co-payment introduced in 2002 did increase end-of-year seasonality in apparent discontinuations in seniors--a finding that deserves further research.
The 2003 transition to income-based pharmacare in British Columbia did not result in significant changes in access to, or continuation of, prescriptions to treat two leading chronic risk factors.
2003年5月，不列颠哥伦比亚省政府采用了基于收入的药物保险计划，取代了基于年龄的计划。既定的政策目标包括维持或加强必要药物的可及性。本研究考察了该政策对两种广泛用于慢性风险因素的药物（抗高血压药和他汀类药物）可及性的影响。
从PharmaNet中提取了1997年至2004年间抗高血压药和他汀类药物的新发病例处方数据。新发病例抗高血压药使用者是指在初始处方日期前在该省居住至少两年后首次开具处方的人。将停止连续开具一系列处方（彼此间隔120天内）的患者数量用作治疗明显中断或中止的衡量指标。我们使用时间序列分析来检验新发病例使用情况和停药情况的变化。
1997年至2004年间，530,167名不列颠哥伦比亚省居民开始使用抗高血压药进行治疗，264,904名不列颠哥伦比亚省居民开始使用他汀类药物进行治疗。按年龄或收入分层时，2003年的政策变化对抗高血压药或他汀类药物的新发病例使用情况没有统计学上的显著影响。同样，2003年的政策也没有改变各年龄和收入组中明显停药率。然而，2002年引入的共付费用确实增加了老年人年末明显停药的季节性——这一发现值得进一步研究。
2003年不列颠哥伦比亚省向基于收入的药物保险计划的转变并未导致治疗两种主要慢性风险因素的处方的可及性或持续性发生显著变化。
