Zhang Yuting, Lee Bruce Y, Donohue Julie M
Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, 130 De Soto St, Crabtree Hall, Room A664, Pittsburgh, PA 15261, USA.
Arch Intern Med. 2010 Aug 9;170(15):1308-14. doi: 10.1001/archinternmed.2010.235.
Several studies have shown that use of medications to treat chronic conditions is highly sensitive to out-of-pocket price and influenced by changes in insurance coverage. Because antibiotics target infections and are used for a short period, one may expect antibiotic use to be less responsive to price. However, no studies have evaluated how antibiotic use changes with drug coverage. We evaluate changes in ambulatory oral antibiotic use after implementation of the Medicare drug benefit (Part D).
We conducted a comparison group analysis 2 years before and after implementation of Part D using insurance claims data from a large Medicare Advantage plan (January 1, 2004, through December 31, 2007). Outcomes included the likelihood of using any oral antibiotics and major antibiotic subclasses among 35 102 older adults and rates of antibiotic use among those with pneumonia and other acute respiratory tract infections.
Overall antibiotic use increased most among those who did not previously have drug coverage (relative odds ratio [OR], 1.58; 95% confidence interval [CI], 1.36-1.85). Use of the broad spectrum antibiotic subclasses of quinolones (OR, 1.70; 95% CI, 1.35-2.15) and macrolides (1.59; 1.26-2.01) increased more than the use of other subclasses, especially for those with prior drug coverage. Rates of ambulatory antibiotic use associated with pneumonia increased (OR, 3.60; 95% CI, 2.35-5.53) more than those associated with other acute respiratory tract infections (2.29; 1.85-2.83).
Antibiotic use increased among older adults whose drug coverage improved after Part D implementation, with the largest increases for broad spectrum, newer, and more expensive antibiotics. Our study suggests reimbursement may play a role in addressing inappropriate antibiotic use.
多项研究表明，用于治疗慢性病的药物使用对自付费用高度敏感，并受保险覆盖范围变化的影响。由于抗生素针对感染且使用时间较短，人们可能预期抗生素使用对价格的反应较小。然而，尚无研究评估抗生素使用如何随药物覆盖范围变化。我们评估了医疗保险药品福利（D 部分）实施后门诊口服抗生素使用的变化。
我们使用来自一个大型医疗保险优势计划（2004 年 1 月 1 日至 2007 年 12 月 31 日）的保险理赔数据，在 D 部分实施前后两年进行了比较组分析。结果包括 35102 名老年人中使用任何口服抗生素和主要抗生素亚类的可能性，以及肺炎和其他急性呼吸道感染患者的抗生素使用率。
总体抗生素使用在以前没有药物覆盖的人群中增加最多（相对优势比[OR]，1.58；95%置信区间[CI]，1.36 - 1.85）。喹诺酮类（OR，1.70；95%CI，1.35 - 2.15）和大环内酯类（1.59；1.26 - 2.01）等广谱抗生素亚类的使用增加幅度大于其他亚类，尤其是对于那些以前有药物覆盖的人群。与肺炎相关的门诊抗生素使用率增加（OR，3.60；95%CI，2.35 - 5.53）幅度大于与其他急性呼吸道感染相关的使用率（2.29；1.85 - 2.83）。
在 D 部分实施后药物覆盖范围改善的老年人中抗生素使用增加，广谱、更新和更昂贵的抗生素增加幅度最大。我们的研究表明报销可能在解决不适当的抗生素使用方面发挥作用。
