Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Rockville, Maryland 20850, USA.
Pharmacoeconomics. 2010;28(1):23-34. doi: 10.2165/11313810-000000000-00000.
With the rapid growth in the volume of HIV-related studies that address drug interactions, appropriate medication regimens, and when and how to alter drug regimens, it is challenging for physicians to stay informed. Physicians require knowledge about all drugs taken by HIV patients in order to assess accurately the benefits and risks of various drug combinations.
To examine the cost and frequency of antiretroviral prescribing errors among a sample of privately insured patients with HIV disease.
Data were obtained from the MarketScan Commercial Claims and Encounter Database created by the Medstat Group Inc. The MarketScan database contains claims data for inpatient care, outpatient care, physician services and prescription drugs in benefit plans sponsored by >50 large employers in the US. This study compared data from the 1999-2000 MarketScan database with those from the 2005 MarketScan database. The 2005 MarketScan database includes 12,226 HIV enrollees who received antiretroviral drugs. This study compared the claims experience of HIV patients who filled a prescription for a drug combination that is not recommended by the US Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents with the claims experience of patients who did not receive such a prescription.
In the 1999-2000 database the most common inappropriate drug combination involved the co-administration of a protease inhibitor (PI) and the lipid-lowering drug simvastatin, and 1% of patients experienced this type of error. In the 2005 database, only 0.4% of patients (46 of 12,226) experienced an inappropriate combination of simvastatin and a PI while 5.3% of patients (644 of 12,226) received atazanavir and tenofovir without ritonavir (referred to herein as 'boosting errors'). Patients who experienced a boosting error incurred higher annual costs than patients who took ritonavir along with tenofovir and atazanavir ($US 20,927 vs $US 16,704). Because atazanavir was approved by the US FDA in June 2003, medication errors involving atazanavir were not relevant in 1999 and 2000. Overall, it was found that HIV patients were three times as likely to experience an inappropriate drug combination in 2005 than they were in either 1999 or 2000 (5.9% vs 1.9%), and that this increase is attributable to boosting errors. In addition, the prevalence rate of HIV in the 2005 MarketScan database was almost triple that in the 1999 MarketScan database (0.14% vs 0.05%).
This study indicates that those who provide care to HIV patients must be vigilant in their efforts to provide patients with a drug therapy regimen that minimizes the chance of an adverse reaction and maximizes the potential to control viral replication.
随着与 HIV 相关的研究数量迅速增长，这些研究涉及药物相互作用、适当的药物治疗方案，以及何时以及如何改变药物治疗方案，医生很难及时了解这些信息。医生需要了解 HIV 患者所服用的所有药物，以便准确评估各种药物组合的益处和风险。
检查在一个私人保险的 HIV 患者样本中，抗逆转录病毒药物处方错误的成本和频率。
数据来自 Medstat Group Inc. 创建的 MarketScan 商业索赔和就诊数据库。MarketScan 数据库包含美国 50 多家大型雇主赞助的医疗保险计划中的住院护理、门诊护理、医生服务和处方药的索赔数据。本研究将 1999-2000 年 MarketScan 数据库的数据与 2005 年 MarketScan 数据库的数据进行了比较。2005 年 MarketScan 数据库包括 12226 名接受抗逆转录病毒药物治疗的 HIV 参保者。本研究比较了因处方药物组合不符合美国卫生与公众服务部抗逆转录病毒成人和青少年指南专家组建议而导致的药物处方错误的 HIV 患者的索赔经验，与未接受此类处方的患者的索赔经验。
在 1999-2000 年数据库中，最常见的不适当药物组合涉及联合使用蛋白酶抑制剂（PI）和降血脂药物辛伐他汀，1%的患者出现这种类型的错误。在 2005 年数据库中，只有 0.4%的患者（12226 名患者中的 46 名）出现了辛伐他汀和 PI 的不适当联合，而 5.3%的患者（12226 名患者中的 644 名）接受了阿扎那韦和替诺福韦而没有利托那韦（此处称为“增效错误”）。出现增效错误的患者的年成本高于同时服用替诺福韦和阿扎那韦加利托那韦的患者（US$20927 比 US$16704）。由于阿扎那韦于 2003 年 6 月获得美国 FDA 批准，因此在 1999 年和 2000 年，与阿扎那韦相关的药物错误并不相关。总体而言，与 1999 年或 2000 年相比，2005 年 HIV 患者发生不适当药物组合的可能性是其三倍（5.9%比 1.9%），这一增长归因于增效错误。此外，2005 年 MarketScan 数据库中 HIV 的患病率几乎是 1999 年 MarketScan 数据库的三倍（0.14%比 0.05%）。
本研究表明，为 HIV 患者提供护理的人员必须保持警惕，努力为患者提供药物治疗方案，最大程度地减少不良反应的机会，并最大限度地提高控制病毒复制的潜力。
Zotero 插件