Semilla April P, Chen Fang, Dall Timothy M
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Am J Manag Care. 2015 Jul;21(9 Suppl):s165-71.
Medicare Part D is a prescription drug program that provides seniors and disabled individuals enrolled in Medicare with outpatient drug coverage benefits. Part D has been shown to increase access to medicines and improve medication adherence; however, the effect of Part D on health outcomes has not yet been extensively studied. In this study, we used a published and validated Markov-based microsimulation model to quantify the relationships among medication use, disease incidence and severity, and mortality. Based on the simulation results, we estimate that since the implementation of Part D in 2006, nearly 200,000 Medicare beneficiaries have lived at least 1 year longer. Reductions in mortality have occurred because of fewer deaths associated with medication-sensitive conditions such as diabetes, congestive heart failure, stroke, and myocardial infarction. Improved access to medication through Medicare Part D helps patients improve blood pressure, cholesterol, and blood glucose levels, which in turn can prevent or delay the onset of disease and the incidence of adverse health events, thus reducing mortality.
医疗保险D部分是一项处方药计划，为参加医疗保险的老年人和残疾人提供门诊药物覆盖福利。事实证明，D部分增加了药品可及性并改善了用药依从性；然而，D部分对健康结果的影响尚未得到广泛研究。在本研究中，我们使用一个已发表并经验证的基于马尔可夫的微观模拟模型来量化药物使用、疾病发病率和严重程度以及死亡率之间的关系。根据模拟结果，我们估计自2006年实施D部分以来，近20万医疗保险受益人多活了至少1年。死亡率的降低是因为与糖尿病、充血性心力衰竭、中风和心肌梗死等药物敏感疾病相关的死亡减少。通过医疗保险D部分改善药品可及性有助于患者改善血压、胆固醇和血糖水平，进而可以预防或延迟疾病的发作以及不良健康事件的发生，从而降低死亡率。
