新型抗糖尿病药物在台湾医院的扩散模式：噻唑烷二酮类药物治疗糖尿病的案例。

Diffusion patterns of new anti-diabetic drugs into hospitals in Taiwan: the case of thiazolidinediones for diabetes.

机构信息

Institute of Health and Welfare Policy, National Yang-Ming University, Taipei City, Taiwan.

出版信息

BMC Health Serv Res. 2011 Jan 31;11:21. doi: 10.1186/1472-6963-11-21.

DOI:10.1186/1472-6963-11-21

PMID:21281475

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3042909/

Abstract

BACKGROUND

Diffusion of new drugs in the health care market affects patients' access to new treatment options and health care expenditures. We examined how a new drug class for diabetes mellitus, thiazolidinediones (TZDs), diffused in the health care market in Taiwan.

METHODS

Assuming that monthly hospital prescriptions of TZDs could serve as a micro-market to perform drug penetration studies, we retrieved monthly TZD prescription data for 580 hospitals in Taiwan from Taiwan's National Health Insurance Research Database for the period between March 1, 2001 and December 31, 2005. Three diffusion parameters, time to adoption, speed of penetration (monthly growth on prescriptions), and peak penetration (maximum monthly prescription) were evaluated. Cox proportional hazards model and quantile regressions were estimated for analyses on the diffusion parameters.

RESULTS

Prior hospital-level pharmaceutical prescription concentration significantly deterred the adoption of the new drug class (HR: 0.02, 95%CI = 0.01 to 0.04). Adoption of TZDs was slower in district hospitals (HR = 0.43, 95%CI = 0.24 to 0.75) than medical centers and faster in non-profit hospitals than public hospitals (HR = 1.79, 95%CI = 1.23 to 2.61). Quantile regression showed that penetration speed was associated with a hospital's prior anti-diabetic prescriptions (25%Q: 18.29; 50%Q: 25.57; 75%Q: 30.97). Higher peaks were found in hospitals that had adopted TZD early (25%Q: -40.33; 50%Q: -38.65; 75%Q: -32.29) and in hospitals in which the drugs penetrated more quickly (25%Q: 16.53; 50%Q: 24.91; 75%Q: 31.50).

CONCLUSIONS

Medical centers began to prescribe TZDs earlier, and they prescribed more TZDs at a faster pace. The TZD diffusion patterns varied among hospitals depending accreditation level, ownership type, and prescription volume of Anti-diabetic drugs.

摘要

背景

新药物在医疗市场中的扩散会影响患者获得新治疗方案的机会和医疗支出。我们研究了一种新的糖尿病药物类别——噻唑烷二酮类（TZDs）在台湾医疗市场中的扩散情况。

方法

假设 TZDs 的每月医院处方量可以作为一个微市场来进行药物渗透研究，我们从台湾全民健康保险研究数据库中检索了台湾 580 家医院在 2001 年 3 月 1 日至 2005 年 12 月 31 日期间的 TZD 处方月度数据。评估了三个扩散参数：采用时间、渗透速度（每月处方增长率）和峰值渗透（最高每月处方量）。使用 Cox 比例风险模型和分位数回归进行扩散参数分析。

结果

医院层面的药品处方集中程度显著抑制了新药类别的采用（HR：0.02，95%CI=0.01-0.04）。地区医院（HR=0.43，95%CI=0.24-0.75）比医学中心采用 TZDs 的速度较慢，而非营利医院比公立医院采用 TZDs 的速度较快（HR=1.79，95%CI=1.23-2.61）。分位数回归显示，渗透速度与医院先前的抗糖尿病处方相关（25%Q：18.29；50%Q：25.57；75%Q：30.97）。较早采用 TZD 的医院（25%Q：-40.33；50%Q：-38.65；75%Q：-32.29）和药物渗透速度较快的医院（25%Q：16.53；50%Q：24.91；75%Q：31.50）峰值较高。