2000-2015 年美国新药物和 4 美元通用药物方案对老年人群中膀胱过度活动症治疗的影响。
Impact of New Medications and $4 Generic Programs on Overactive Bladder Treatment Among Older Adults in the United States, 2000-2015.
机构信息
Cecil G. Sheps Center for Health Services Research.
Department of Epidemiology, School of Public Health.
出版信息
Med Care. 2018 Feb;56(2):162-170. doi: 10.1097/MLR.0000000000000858.
BACKGROUND
Despite several new medications being Food and Drug Administration-approved for overactive bladder (OAB) and new prescription drug payment programs, there are limited population-based data regarding OAB medication use among older adults.
OBJECTIVES
To examine: (1) impacts of new medications and $4 generic programs on time trends for OAB-related medication dispensing for older adults in the United States; (2) differences by age and sex; and (3) temporal changes in OAB-related medication payments.
METHODS
Using Truven Health Analytics' Medicare Supplemental Database (2000-2015), we analyzed OAB-related medication claims for 9,477,061 Medigap beneficiaries age 65-104. We estimated dispensing rates (per 1000 person-months), assessed dispensing trends using interrupted time-series methods, compared dispensing rates by age and sex, and summarized payment trends.
RESULTS
From 2000 to 2015, 771,609 individuals filled 13,863,998 OAB-related prescriptions. During 2000-2007, 3 new extended-release medications became available (tolterodine, darifenacin, solifenacin), leading to increases in overall OAB-related dispensing rates by 19.1 (99% confidence interval, 17.0-21.2), a 92% increase since 2000; overall rates remained stable during 2008-2015. By 2015, the most common medications were oxybutynin (38%), solifenacin (20%), tolterodine (19%), and mirabegron (12%). Dispensing rates peaked at age 90 (rate, 53.4; 99% confidence interval, 53.1-53.7). Women had higher rates than men at all ages (average ratewomen-ratemen, 22.0). The gap between upper and lower percentiles of medication payments widened between 2008-2015; by 2015, 25% of reimbursed dispensed prescriptions had total payments exceeding $250.
CONCLUSIONS
Medication-specific dispensing rates for OAB changed when new alternatives became available. Recent changes in utilization and cost of OAB medications have implications for clinical guidelines, pharmacoepidemiologic studies, and payment policies.
背景
尽管有几种新的药物获得了美国食品和药物管理局（FDA）的批准用于治疗膀胱过度活动症（OAB），并且有新的处方药支付计划，但关于老年人使用 OAB 药物的基于人群的数据有限。
目的
研究：（1）新药物和 4 美元通用药物计划对美国老年人 OAB 相关药物配药的时间趋势的影响；（2）按年龄和性别划分的差异；（3）OAB 相关药物支付的时间变化。
方法
利用 Truven Health Analytics 的 Medicare 补充数据库（2000-2015 年），我们分析了 9477061 名年龄在 65-104 岁的 Medigap 受益人的 OAB 相关药物索赔。我们估计了配药率（每千人月），使用中断时间序列方法评估了配药趋势，比较了年龄和性别的配药率，并总结了支付趋势。
结果
从 2000 年到 2015 年，有 771609 人开出了 13863998 张 OAB 相关处方。在 2000-2007 年期间，有 3 种新的缓释药物上市（托特罗定、达非那新、索利那新），导致 OAB 相关配药率整体增加了 19.1%（99%置信区间，17.0-21.2），自 2000 年以来增加了 92%；2008-2015 年期间，整体配药率保持稳定。到 2015 年，最常见的药物是奥昔布宁（38%）、索利那新（20%）、托特罗定（19%）和米拉贝隆（12%）。配药率在 90 岁时达到峰值（比率为 53.4；99%置信区间，53.1-53.7）。在所有年龄段，女性的配药率都高于男性（女性平均配药率-男性配药率，22.0）。2008-2015 年间，药物支付上下百分位之间的差距扩大；到 2015 年，25%的报销处方的总支付超过 250 美元。
结论
当出现新的替代药物时，OAB 的特定药物配药率发生了变化。最近 OAB 药物的利用和成本变化对临床指南、药物流行病学研究和支付政策有影响。
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