奥地利通过等效药物替代降低高血压、高脂血症和糖尿病处方药成本的潜在效果：一项全国队列研究

Potential savings in prescription drug costs for hypertension, hyperlipidemia, and diabetes mellitus by equivalent drug substitution in Austria: a nationwide cohort study.

作者信息

Heinze Georg, Hronsky Milan, Reichardt Berthold, Baumgärtel Christoph, Müllner Marcus, Bucsics Anna, Winkelmayer Wolfgang C

机构信息

Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria,

出版信息

Appl Health Econ Health Policy. 2015 Apr;13(2):193-205. doi: 10.1007/s40258-014-0143-4.

DOI:10.1007/s40258-014-0143-4

PMID:25536928

Abstract

BACKGROUND

Healthcare systems spend considerable proportions of their budgets on pharmaceutical treatment of hypertension, hyperlipidemia, and diabetes mellitus. From data on almost all residents of Austria, a country with mandatory health insurance and universal health coverage, we estimated potential cost savings by substituting prescribed medicines with the cheapest medicines that were of the same chemical substance and strength, and available during the same time.

METHODS

Data from 8.3 million persons (98.5 % of the total Austrian insured population) from 2009-2012 were analyzed. Real prescription costs for antihypertensive, lipid-lowering, and hypoglycemic medicines achievable by same-substance, same-strength drug substitution were computed for each active ingredient, and per gender and 1-year age category of patients.

RESULTS

In 2012, health insurance providers spent 231.3 million, 77.8 million, and 91.9 million for antihypertensive, lipid-lowering, and diabetes medications, of which 52.2 million (22.6 %), 15.9 million (20.5 %), and 4.1 million (4.5 %), respectively, could have been saved by same-substance drug substitution. Highest potential savings were calculated for amlodipine (8.0 million, 65.4 %), simvastatin (12.2 million, 59.3 %), and metformin (2.4 million, 54.6 %), respectively. Higher savings for men than for women resulted from differing prescribed cumulative dosages and proportions of patients with co-payment waiver. Potential cost savings in antihypertensive and lipid-lowering drugs increased from 2009-2012.

CONCLUSION

Our study highlights the cost-savings potential from arguably the most acceptable of interventions, simply switching to the cheapest available same-substance, same-strength product. In 2012, this strategy could have reduced costs for antihypertensive, lipid-lowering, and hypoglycemic treatment by up to 18.0 %.

摘要

背景

医疗保健系统将其预算的相当一部分用于高血压、高脂血症和糖尿病的药物治疗。根据奥地利几乎所有居民的数据（奥地利是一个实行强制医疗保险和全民医保的国家），我们估计了通过用具有相同化学物质和强度且在同一时期可用的最便宜药物替代处方药可能节省的成本。

方法

分析了2009年至2012年来自830万人（占奥地利参保总人口的98.5%）的数据。针对每种活性成分以及患者的性别和每一岁年龄组，计算了通过同物质、同强度药物替代可实现的抗高血压、降脂和降糖药物的实际处方成本。

结果

2012年，医疗保险机构在抗高血压、降脂和糖尿病药物上分别花费了2.313亿欧元、7780万欧元和9190万欧元，其中通过同物质药物替代分别可节省5220万欧元（22.6%）、1590万欧元（20.5%）和410万欧元（4.5%）。氨氯地平（800万欧元，65.4%）、辛伐他汀（1220万欧元，59.3%）和二甲双胍（240万欧元，54.6%）的潜在节省金额最高。由于规定的累积剂量不同以及免共同支付患者的比例不同，男性比女性节省的费用更高。2009年至2012年，抗高血压和降脂药物的潜在成本节省有所增加。