Kreling D H, Knocke D J, Hammel R W
School of Pharmacy, University of Wisconsin, Madison 53706.
Med Care. 1989 Jan;27(1):34-44. doi: 10.1097/00005650-198901000-00004.
The effects of removing propoxyphene napsylate products from the Wisconsin Medicaid drug program formulary were examined. Internal analgesic expenditures and usage data for 3-month periods before and after the removal were compared (April through June 1984 versus the same period in 1985). After adjusting for price and reimbursement changes between the two study periods, overall expenditures were slightly higher after removal of these products. Expenditures per recipient, prescription, and unit all increased, as did the number of prescriptions per recipient. Expenditures, prescriptions, and recipients increased more for propoxyphene hydrochloride products as substitutes for propoxyphene napsylate products than for products in any other category. Increases also occurred for nonsteroidal anti-inflammatory products, suggesting they may have been chosen as replacement therapy. The proportion of napsylate prescriptions converted to hydrochloride prescriptions was larger for institutional patients than for noninstitutional patients. Although program expenditures did not decrease, as intended by the formulary change, other qualitative outcomes also should be considered, such as any therapeutic advantages the replacement products may have had for the patients.
研究了从威斯康星医疗补助药物计划处方集里移除萘磺酸丙氧芬产品的影响。对移除前三个月（1984年4月至6月）和移除后三个月（1985年同期）的内部镇痛药物支出和使用数据进行了比较。在对两个研究期间的价格和报销变化进行调整后，移除这些产品后总体支出略有增加。每位接受者的支出、每张处方的支出和每单位的支出均有所增加，每位接受者的处方数量也增加了。作为萘磺酸丙氧芬产品替代品的盐酸丙氧芬产品的支出、处方和接受者的增加幅度大于任何其他类别的产品。非甾体抗炎产品的支出也有所增加，这表明它们可能被选作替代疗法。机构患者将萘磺酸盐处方转换为盐酸盐处方的比例高于非机构患者。尽管计划支出并未如处方集变更所预期的那样减少，但还应考虑其他定性结果，例如替代产品可能给患者带来的任何治疗优势。
