Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Cancer. 2013 Jul 1;119(13):2494-502. doi: 10.1002/cncr.28084. Epub 2013 Apr 23.
Rates of nonadherence to aromatase inhibitors (AIs) among Medicare beneficiaries with hormone receptor-positive early breast cancer are high. Out-of-pocket drug costs appear to be an important contributor to this and may be addressed by eliminating copayments and other forms of patient cost sharing. The authors estimated the incremental cost-effectiveness of providing Medicare beneficiaries with full prescription coverage for AIs compared with usual prescription coverage under the Medicare Part D program.
A Markov state-transition model was developed to simulate AI use and disease progression in a hypothetical cohort of postmenopausal Medicare beneficiaries with hormone receptor-positive early breast cancer. The analysis was conducted from the societal perspective and considered a lifetime horizon. The main outcome was an incremental cost-effectiveness ratio, which was measured as the cost per quality-adjusted life-year (QALY) gained.
For patients receiving usual prescription coverage, average quality-adjusted survival was 11.35 QALYs, and lifetime costs were $83,002. For patients receiving full prescription coverage, average quality-adjusted survival was 11.38 QALYs, and lifetime costs were $82,728. Compared with usual prescription coverage, full prescription coverage would result in greater quality-adjusted survival (0.03 QALYs) and less resource use ($275) per beneficiary. From the perspective of Medicare, full prescription coverage was cost-effective (incremental cost-effectiveness ratio, $15,128 per QALY gained) but not cost saving.
Providing full prescription coverage for AIs to Medicare beneficiaries with hormone receptor-positive early breast cancer would both improve health outcomes and save money from the societal perspective.
医疗保险受益人群中患有激素受体阳性早期乳腺癌的患者对芳香化酶抑制剂（AIs）的不依从率很高。自付药费似乎是造成这一现象的一个重要因素，可以通过取消共付额和其他形式的患者分担费用来解决。作者估计，与医疗保险 D 部分计划的常规处方覆盖相比，为医疗保险受益人群提供 AIs 全额处方覆盖的增量成本效益。
开发了一个马尔可夫状态转移模型，以模拟绝经后患有激素受体阳性早期乳腺癌的医疗保险受益人群中 AIs 的使用和疾病进展。分析从社会角度进行，并考虑了终生的时间范围。主要结果是增量成本效益比，即每获得一个质量调整生命年（QALY）的增量成本。
对于接受常规处方覆盖的患者，平均质量调整生存为 11.35 QALY，终生费用为 83002 美元。对于接受全额处方覆盖的患者，平均质量调整生存为 11.38 QALY，终生费用为 82728 美元。与常规处方覆盖相比，全额处方覆盖将使每个受益人的质量调整生存（0.03 QALY）增加，并使资源使用（每位受益人的 275 美元）减少。从医疗保险的角度来看，全额处方覆盖具有成本效益（增量成本效益比，每获得一个 QALY 增加 15128 美元），但不节省成本。
为患有激素受体阳性早期乳腺癌的医疗保险受益人群提供 AIs 的全额处方覆盖，从社会角度来看，既能改善健康结果，又能节省资金。
