限制报销对改善降压治疗成本效益的初步影响。

Initial effects of a reimbursement restriction to improve the cost-effectiveness of antihypertensive treatment.

机构信息

Karolinska Institutet, Centre for Pharmacoepidemiology, Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.

出版信息

Health Policy. 2010 Mar;94(3):221-9. doi: 10.1016/j.healthpol.2009.09.014. Epub 2009 Oct 29.

DOI:10.1016/j.healthpol.2009.09.014

PMID:19879009

Abstract

OBJECTIVE

The Swedish Dental and Pharmaceutical Benefits Agency is re-assessing the value of all drugs included in the reimbursement scheme in order to make the most efficient use of resources. Their recent review of antihypertensive drugs included 46 substances with total annual sales of euro230 million (euro25/capita). This resulted in reimbursement restrictions for 26 substances, e.g. all angiotensin receptor blockers (ARBs).

METHODS

We used the Swedish prescribed drug register to evaluate the initial effects on prescribing patterns using a before-and-after design, comparing utilization and expenditure with corresponding periods previous years.

RESULTS

The proportion of the Swedish population being dispensed antihypertensive drugs increased by 0.5%-units to 16.5% in September-December 2008 compared to the same period in 2007. Patients initiated on ARBs decreased by 24%, whilst increasing for ACE inhibitors (ACEI) and calcium channel blockers, by 14% and 12%, respectively. The proportion initiated on ARBs prescribed an ACEI within 24 months prior to an ARB increased from 51% to 67%, with a substantial regional variation (extremal quotient 31; coefficient of variation 36%). The total expenditure decreased by 4.7% to euro73 million in September-December 2008 compared to the same period in 2007.

CONCLUSIONS

Reimbursement restrictions had a positive impact on enhancing the efficiency of antihypertensive prescribing. Resources released can be used to improve care in the future.

摘要

目的

为了更有效地利用资源，瑞典牙科和药品福利局正在重新评估纳入报销计划的所有药物的价值。他们最近对降压药物的审查包括 46 种总年销售额为 2.3 亿欧元（每人 25 欧元）的药物。这导致 26 种药物的报销受到限制，例如所有血管紧张素受体阻滞剂（ARB）。

方法

我们使用瑞典处方药物登记处，通过前后设计评估处方模式的初始影响，比较与前几年同期相对应的利用和支出情况。

结果

与 2007 年同期相比，2008 年 9 月至 12 月，接受降压药物治疗的瑞典人口比例增加了 0.5 个单位，达到 16.5%。开始使用 ARB 的患者减少了 24%，而 ACE 抑制剂（ACEI）和钙通道阻滞剂的使用则分别增加了 14%和 12%。在开始使用 ARB 之前的 24 个月内，处方 ACEI 的 ARB 患者比例从 51%增加到 67%，存在显著的区域差异（极值商 31；变异系数 36%）。2008 年 9 月至 12 月，与 2007 年同期相比，支出总额减少了 4.7%，至 7300 万欧元。