退伍军人事务部和医疗保险处方药 D 部分糖尿病患者的品牌处方药使用情况：全国队列比较。
Brand-name prescription drug use among Veterans Affairs and Medicare Part D patients with diabetes: a national cohort comparison.
机构信息
Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, 7180 Highland Drive, Pittsburgh, PA 15206, USA.
出版信息
Ann Intern Med. 2013 Jul 16;159(2):105-14. doi: 10.7326/0003-4819-159-2-201307160-00664.
BACKGROUND
Medicare Part D and the U.S. Department of Veterans Affairs (VA) use different approaches to manage prescription drug benefits, with implications for spending. Medicare relies on private plans with distinct formularies, whereas the VA administers its own benefit using a national formulary.
OBJECTIVE
To compare overall and regional rates of brand-name drug use among older adults with diabetes in Medicare and the VA.
DESIGN
Retrospective cohort.
SETTING
Medicare and the VA, 2008.
PATIENTS
1,061,095 Medicare Part D beneficiaries and 510,485 veterans aged 65 years or older with diabetes.
MEASUREMENTS
Percentage of patients taking oral hypoglycemics, statins, and angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) who filled brand-name drug prescriptions and percentage of patients taking long-acting insulins who filled analogue prescriptions. Sociodemographic- and health status-adjusted hospital referral region (HRR) brand-name drug use was compared, and changes in spending were calculated if use of brand-name drugs in 1 system mirrored the other.
RESULTS
Brand-name drug use in Medicare was 2 to 3 times that in the VA: 35.3% versus 12.7% for oral hypoglycemics, 50.7% versus 18.2% for statins, 42.5% versus 20.8% for ACE inhibitors or ARBs, and 75.1% versus 27.0% for insulin analogues. Adjusted HRR-level brand-name statin use ranged (from the 5th to 95th percentiles) from 41.0% to 58.3% in Medicare and 6.2% to 38.2% in the VA. For each drug group, the 95th-percentile HRR in the VA had lower brand-name drug use than the 5th-percentile HRR in Medicare. Medicare spending in this population would have been $1.4 billion less if brand-name drug use matched that of the VA.
LIMITATION
This analysis cannot fully describe the factors underlying differences in brand-name drug use.
CONCLUSION
Medicare beneficiaries with diabetes use 2 to 3 times more brand-name drugs than a comparable group within the VA, at substantial excess cost.
背景
医疗保险处方药计划（Medicare Part D）和美国退伍军人事务部（VA）采用不同的方法来管理处方药福利，这对支出有影响。医疗保险依赖于具有不同处方的私人计划，而退伍军人事务部则使用国家处方来管理其自身的福利。
目的
比较医疗保险和退伍军人事务部中患有糖尿病的老年人使用品牌药物的总体和区域比率。
设计
回顾性队列研究。
设置
医疗保险和退伍军人事务部，2008 年。
患者
1061095 名医疗保险处方药计划 D 部分受益人和 510485 名年龄在 65 岁或以上的患有糖尿病的退伍军人。
测量指标
服用口服降糖药、他汀类药物、血管紧张素转换酶（ACE）抑制剂或血管紧张素受体阻滞剂（ARB）的患者中使用品牌药物处方的比例，以及使用长效胰岛素的患者中使用类似物处方的比例。比较调整了社会人口统计学和健康状况的医院推荐区域（HRR）品牌药物使用情况，如果一种系统中品牌药物的使用反映了另一种系统的使用情况，则计算支出的变化。
结果
医疗保险中的品牌药物使用率是退伍军人事务部的 2 到 3 倍：口服降糖药为 35.3%比 12.7%，他汀类药物为 50.7%比 18.2%，ACE 抑制剂或 ARB 为 42.5%比 20.8%，胰岛素类似物为 75.1%比 27.0%。调整后的 HRR 级别品牌他汀类药物使用率范围（第 5 到 95 个百分位数）在医疗保险中为 41.0%到 58.3%，在退伍军人事务部中为 6.2%到 38.2%。对于每个药物组，退伍军人事务部的第 95 个百分位 HRR 的品牌药物使用率低于医疗保险中第 5 个百分位 HRR。如果品牌药物的使用与退伍军人事务部的使用相匹配，该人群的医疗保险支出将减少 14 亿美元。
局限性
本分析无法充分描述品牌药物使用差异的根本原因。
结论
患有糖尿病的医疗保险受益人使用品牌药物的比例是退伍军人事务部中同类人群的 2 到 3 倍，而且成本过高。
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