Ku Li-Jung E, Pai Ming-Chyi
Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Division of Behavioral Neurology, Department of Neurology and Alzheimer's Disease Center, Medical College and Hospital, National Cheng Kung University, Tainan, Taiwan.
Int Psychogeriatr. 2014 May;26(5):795-804. doi: 10.1017/S1041610213002603. Epub 2014 Jan 16.
Pharmaceutical therapy for patients with dementia including cholinesterase inhibitors (ChEI) and memantine is covered by Taiwan's National Health Insurance (NHI) but with strict reimbursement criteria. This study compared utilization of selected cognitive enhancers among elderly patients with dementia and estimated associated differences in medical care costs.
This study used medical claims and pharmacy claims from the NHI Research Database of Taiwan from 2009 to 2011, which included all patients 65 years or older diagnosed with dementia in their outpatient or inpatient claims. Both individual-level and market-level analysis were performed to calculate the average medical costs per person and the share of drug expenditures. Generalized linear models with propensity score adjustment estimated differences in medical care costs by use of selected cognitive enhancers.
Users of ChEI had the highest medication and outpatient costs but the lowest inpatient costs among all users of cognitive enhancers. However, annual adjusted total medical care costs per ChEI user were not significantly different from those who used cerebral vasodilators (CBV). In 2011, 52.4% of the elderly with dementia in Taiwan used cognitive enhancers, but among them 88.3% used CBV while 9.2% used ChEI. Among patients with dementia who used at least one cognitive enhancer, the aggregated expenditure as a share of their total drug expenditures was 9.7% in 2011.
Given that CBV had a much higher utilization rate than ChEI or memantine among elderly people with dementia, the strict reimbursement policy for ChEI and memantine may need to be revisited to increase access to those drugs by patients with dementia in Taiwan.
台湾全民健康保险（NHI）涵盖了用于痴呆症患者的药物治疗，包括胆碱酯酶抑制剂（ChEI）和美金刚，但报销标准严格。本研究比较了老年痴呆症患者对特定认知增强剂的使用情况，并估计了医疗费用的相关差异。
本研究使用了台湾NHI研究数据库2009年至2011年的医疗理赔和药房理赔数据，其中包括所有在门诊或住院理赔中被诊断为痴呆症的65岁及以上患者。进行了个体层面和市场层面的分析，以计算人均医疗费用和药物支出份额。使用倾向得分调整的广义线性模型估计了使用特定认知增强剂的医疗费用差异。
在所有认知增强剂使用者中，ChEI使用者的药物和门诊费用最高，但住院费用最低。然而，每位ChEI使用者的年度调整后总医疗费用与使用脑血管扩张剂（CBV）的使用者并无显著差异。2011年，台湾88.3%的老年痴呆症患者使用CBV，9.2%使用ChEI。在使用至少一种认知增强剂的痴呆症患者中，2011年其总药物支出中认知增强剂的累计支出占比为9.7%。
鉴于CBV在老年痴呆症患者中的使用率远高于ChEI或美金刚，可能需要重新审视ChEI和美金刚的严格报销政策，以增加台湾痴呆症患者对这些药物的可及性。
