Seaman Karla L, Sanfilippo Frank M, Roughead Elizabeth E, Bulsara Max K, Kemp-Casey Anna, Bulsara Caroline, Watts Gerald F, Preen David
School of Health Sciences, The University of Notre Dame, Fremantle, Western Australia, Australia.
Cardiovasular Research, School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia.
BMJ Open. 2017 Jun 21;7(6):e013691. doi: 10.1136/bmjopen-2016-013691.
Across the world, health systems are adopting approaches to manage rising healthcare costs. One common strategy is a medication copayments scheme where consumers make a contribution (copayment) towards the cost of their dispensed medicines, with remaining costs subsidised by the health insurance service, which in Australia is the Federal Government.In Australia, copayments have tended to increase in proportion to inflation, but in January 2005, the copayment increased substantially more than inflation. Results from aggregated dispensing data showed that this increase led to a significant decrease in the use of several medicines. The aim of this study is to determine the demographic and clinical characteristics of individuals ceasing or reducing statin medication use following the January 2005 Pharmaceutical Benefit Scheme (PBS) copayment increase and the effects on their health outcomes.
This whole-of-population study comprises a series of retrospective, observational investigations using linked administrative health data on a cohort of West Australians (WA) who had at least one statin dispensed between 1 May 2002 and 30 June 2010. Individual-level data on the use of pharmaceuticals, general practitioner (GP) visits, hospitalisations and death are used.This study will identify patients who were stable users of statin medication in 2004 with follow-up commencing from 2005 onwards. Subgroups determined by change in adherence levels of statin medication from 2004 to 2005 will be classified as continuation, reduction or cessation of statin therapy and explored for differences in health outcomes and health service utilisation after the 2005 copayment change.
Ethics approvals have been obtained from the Western Australian Department of Health (#2007/33), University of Western Australia (RA/4/1/1775) and University of Notre Dame (0 14 167F). Outputs from the findings will be published in peer reviewed journals designed for a policy audience and presented at state, national and international conferences.
在全球范围内，卫生系统都在采用各种方法来应对不断上涨的医疗费用。一种常见的策略是药物共付计划，即消费者需为所配药物支付一定费用（共付额），其余费用由医疗保险服务机构补贴，在澳大利亚，该机构为联邦政府。在澳大利亚，共付额往往会随着通货膨胀而增加，但在2005年1月，共付额的增长幅度大幅超过了通货膨胀率。汇总配药数据的结果显示，这一增长导致几种药物的使用量显著下降。本研究的目的是确定在2005年1月药品福利计划（PBS）共付额增加后停止或减少他汀类药物使用的个体的人口统计学和临床特征，以及对其健康结果的影响。
这项全人群研究包括一系列回顾性观察性调查，使用了与西澳大利亚州（WA）一组人群相关的行政卫生数据，这些人在2002年5月1日至2010年6月30日期间至少配过一次他汀类药物。使用了关于药品使用、全科医生（GP）就诊、住院和死亡的个体层面数据。本研究将确定2004年他汀类药物稳定使用者，并从2005年开始进行随访。根据2004年至2005年他汀类药物依从水平的变化确定的亚组将被分类为他汀类治疗的持续、减少或停止，并探讨2005年共付额变化后健康结果和卫生服务利用方面的差异。
已获得西澳大利亚卫生部（#2007/33）、西澳大利亚大学（RA/4/1/1775）和圣母大学（0 14 167F）的伦理批准。研究结果将发表在面向政策受众的同行评审期刊上，并在州、国家和国际会议上展示。
