Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, Florey, Building 54, Mills Road, Acton, ACT, 2601, Australia.
Centre for Health Economics Research and Evaluation, University of Technology Sydney, Level 2, Building 5 Block D 1-59 Quay St Haymarket, Sydney, NSW, 2000, Australia.
Appl Health Econ Health Policy. 2017 Oct;15(5):625-634. doi: 10.1007/s40258-017-0336-8.
In Australia, as in many other Western countries, patient surveys suggest the costs of medicines lead to deferring or avoiding filling of prescriptions. The Australian Pharmaceutical Benefits Scheme provides approved prescription medicines at subsidised prices with relatively low patient co-payments. The Pharmaceutical Benefits Scheme defines patient co-payment levels per script depending on whether patients are "concessional" (holding prescribed pension or other government concession cards) or "general", and whether they have reached a safety net defined by total out-of-pocket costs for Pharmaceutical Benefits Scheme-approved medicines.
The purpose of this study was to explore the impact of costs on adherence to statins in this relatively low-cost environment.
Using data from a large-scale survey of older Australians in the state of New South Wales linked to administrative data from the national medical and pharmaceutical insurance schemes, we explore the relationships between adherence to medication regimes for statins and out-of-pocket costs of prescribed pharmaceuticals, income, other health costs, and a wide set of demographic and socio-economic control variables using both descriptive analysis and logistic regressions.
Within the general non-safety net group, which has the highest co-payment, those with lowest income have the lowest adherence, suggesting that the general safety threshold may be set at a level that forms a major barrier to statin adherence. This is reinforced by over 75% of those who were not adherent before reaching the safety net threshold becoming adherent after reaching the safety net with its lower co-payments.
The main financial determinant of adherence is the concessional/general and safety net category of the patient, which means the main determinant is the level of co-payment.
在澳大利亚，和许多其他西方国家一样，患者调查表明药品费用导致了处方的延迟或避免开具。澳大利亚药品福利计划以补贴价格提供已批准的处方药，患者只需支付相对较低的自付费用。药品福利计划根据患者是否为“优惠”（持有规定的养老金或其他政府优惠卡）或“普通”，以及他们是否达到了由药品福利计划批准的药品总自付费用定义的安全网，来确定每张处方的患者自付费用水平。
本研究旨在探索在这种相对低成本的环境下，成本对他汀类药物依从性的影响。
我们使用了新南威尔士州一项针对老年澳大利亚人的大规模调查的数据，并将其与国家医疗和药品保险计划的行政数据相链接，利用描述性分析和逻辑回归，探索了他汀类药物用药方案的依从性与处方药自付费用、收入、其他健康费用以及广泛的人口统计学和社会经济控制变量之间的关系。
在自付费用最高的普通非安全网组中，收入最低的患者依从性最低，这表明普通安全网门槛可能设定在一个对他汀类药物依从性构成重大障碍的水平。在达到安全网门槛之前没有依从的人中，超过 75%的人在达到安全网并降低自付费用后变得依从，这进一步证实了这一点。
依从性的主要财务决定因素是患者的优惠/普通和安全网类别，这意味着主要决定因素是自付费用水平。
