Fung Vicki, Price Mary, Busch Alisa B, Landrum Mary Beth, Fireman Bruce, Nierenberg Andrew A, Newhouse Joseph P, Hsu John
50 Staniford St, 9th Fl, Boston, MA 02114. E-mail:
Am J Manag Care. 2016 Jan;22(1):41-8.
The introduction of generic second-generation antipsychotics (SGAs), starting with risperidone in July 2008, could reduce antipsychotic spending and cost-related use barriers. This study examines associations between generic risperidone use and spending and adherence after introduction among Medicare Advantage (MA) beneficiaries.
Historic cohort study.
The study included MA beneficiaries receiving SGA treatment prior to July 2008. We examined antipsychotic spending using linear models, adherence (proportion of days covered ≥ 80%) using logistic models, and nonpersistence (time to first gap in antipsychotic use > 30 days) in 2009 using Cox proportional hazard models, comparing beneficiaries with versus without generic use, adjusting for individual and plan characteristics.
Between July 2008 and December 2009, 22.8% of beneficiaries had ≥ 1 fill of generic risperidone: 73% of those previously using branded risperidone and 6.7% of those previously using other SGAs. Beneficiaries in private fee-for-service (FFS) versus health maintenance organization (HMO) plans had lower rates of generic use (hazard ratio [HR], 0.73 [95% CI, 0.56-0.96]); however, cost-sharing levels were not associated with generic use. Compared with beneficiaries who continued using other SGAs, those who switched from other SGAs to generic risperidone in 2008 had lower out-of-pocket spending (-$214; 95% CI, -$314 to -$115), higher adherence (odds ratio, 2.34; 95% CI, 1.62-3.40) and lower rates of nonpersistence (HR, 0.56; 95% CI, 0.46-0.69) in 2009.
Generic use was concentrated among patients previously using branded risperidone. HMO plans appeared to be more effective at encouraging generic use than unmanaged private FFS plans; however, patient financial incentives had limited influence on switching. Additional opportunity remains to encourage greater generic SGA use, reduce spending, and potentially improve treatment adherence and outcomes.
自2008年7月利培酮率先上市以来，第二代非专利抗精神病药物（SGA）的引入可降低抗精神病药物支出及与费用相关的使用障碍。本研究探讨了医疗保险优势（MA）受益人群中使用非专利利培酮与引入后支出、依从性之间的关联。
历史性队列研究。
研究纳入了2008年7月前接受SGA治疗的MA受益人。我们使用线性模型研究抗精神病药物支出，使用逻辑模型研究依从性（覆盖天数比例≥80%），并在2009年使用Cox比例风险模型研究非持续性（抗精神病药物使用首次中断>30天的时间），比较使用与未使用非专利药物的受益人，并对个体和计划特征进行调整。
2008年7月至2009年12月期间，22.8%的受益人至少有1次非专利利培酮配药记录：其中73%曾使用品牌利培酮，6.7%曾使用其他SGA。与健康维护组织（HMO）计划相比，参加私人按服务收费（FFS）计划的受益人使用非专利药物的比例较低（风险比[HR]，0.73[95%CI，0.56 - 0.96]）；然而，费用分担水平与使用非专利药物无关。与继续使用其他SGA的受益人相比，2008年从其他SGA改用非专利利培酮的受益人自付费用较低（-$214；95%CI，-$314至-$115），依从性较高（优势比，2.34；95%CI，1.62 - 3.40），2009年非持续性发生率较低（HR，0.56；95%CI，0.46 - 0.69）。
非专利药物的使用集中在曾使用品牌利培酮的患者中。HMO计划在鼓励使用非专利药物方面似乎比无管理的私人FFS计划更有效；然而，患者的经济激励对换药的影响有限。仍有更多机会鼓励更广泛地使用非专利SGA，降低支出，并可能改善治疗依从性和治疗效果。
