Smieliauskas Fabrice, Sharma Hari, Hurley Connor, de Souza Jonas A, Shih Ya-Chen Tina
Department of Public Health Sciences, University of Chicago, Chicago, IL, USA.
Chicago, IL, USA.
Health Econ. 2018 Jan;27(1):e55-e70. doi: 10.1002/hec.3537. Epub 2017 Jul 20.
Access to cancer drugs used off-label is important to cancer patients but may drive up healthcare costs with little evidence of clinical benefit. We hypothesized that state health insurance mandates for private insurers to provide coverage for off-label use of cancer drugs cause higher rates of off-label use. We used Truven MarketScan data from 1999 to 2007 on utilization of 35 infused chemotherapy drugs in private health plans in the United States, covering the period when eight states implemented off-label coverage laws. We studied trends in off-label use of drugs, distinguishing between appropriate and inappropriate off-label use according to drug compendia, and estimated difference-in-difference regressions of the effect of state laws on off-label use. We estimate 41% of utilization was off-label, including 17% of use conservatively defined as inappropriate. Trends show gradual declines in off-label use over time. We also find no discernable effect of state laws mandating coverage of off-label use of cancer drugs on utilization patterns under multiple empirical specifications. Our conclusion is that policymakers should consider shifting away from mandating coverage as a way to ensure access to drugs off-label and towards incentivizing adherence to clinical practice guidelines to improve the quality and value of off-label use.
使用癌症药物的非标签用药对癌症患者很重要，但可能会推高医疗成本，且几乎没有临床获益的证据。我们假设，州健康保险要求私人保险公司为癌症药物的非标签用药提供保险会导致更高的非标签用药率。我们使用了1999年至2007年Truven MarketScan关于美国私人健康保险计划中35种注射用化疗药物使用情况的数据，涵盖了八个州实施非标签用药保险法的时期。我们研究了药物非标签用药的趋势，根据药品集区分适当和不适当的非标签用药，并估计了州法律对非标签用药影响的双重差分回归。我们估计41%的用药为非标签用药，其中17%的用药被保守地定义为不适当用药。趋势显示非标签用药随时间逐渐下降。我们还发现在多种实证规范下，州法律要求为癌症药物的非标签用药提供保险对用药模式没有明显影响。我们的结论是，政策制定者应考虑从强制保险作为确保获得非标签用药的方式转向激励遵守临床实践指南，以提高非标签用药的质量和价值。
