Flinterman Linda E, Hek Karin, Korevaar Joke C, van Dijk Liset
NIVEL Netherlands Institute for Health Services Research, Utrecht, Netherlands.
Front Public Health. 2018 Feb 27;6:51. doi: 10.3389/fpubh.2018.00051. eCollection 2018.
Governments have several options to reduce the increasing costs of health care, including restrictions for the reimbursement of medicines. Next to the intended effect of reduced costs for medicines, reimbursement restriction can have unintended effects such as patients refraining from their treatment which may lead to health problems and increased use of health care. An example of a reimbursement restriction is the one for proton pump inhibitors (PPIs) that became effective in the Netherlands in January 2012. A major unintended effect of this measure could be that high-risk patients who start with non-steroidal anti-inflammatory drugs (NSAIDs) or low-dose aspirin (aspirin) and who have an increased risk of gastric complications for which they are prescribed PPIs refrain from this PPI treatment. The aim of this study was to evaluate the effect of the reimbursement restriction among high-risk users of NSAIDs or aspirin. Do these patients refrain from their PPI treatment and if so do they have an increased risk of gastric complications? Part of the patients starting with NSAIDs or aspirin have an increased risk of gastric complications due to their age, comorbidities, or co-medication. The incidence of PPI use during the 2 years before the reimbursement restriction (2010 and 2011) and 2 years after the introduction of the reimbursement restriction was compared for patients on NSAIDs or aspirin with an increased risk of developing gastric complications. Impact of age, sex, and social economic status (SES) was taken into account. Hospital admissions due to gastric complications were studied over the same period (2010-2013). Data were obtained from a large population-based primary care database and a hospital database. The use of PPIs in patients with an increased risk of gastric complications who started NSAID/aspirin increased from 40% in 2010 to 55% in 2013. No impact was found of age, sex, or SES. There was no increase in hospital admissions due to gastric complications after the reimbursement restriction. The reimbursement restriction on PPIs was not associated with any detectable unintended effects for patients with an increased risk of gastric complications.
政府有多种选择来降低不断增加的医疗保健成本，包括对药品报销进行限制。除了降低药品成本的预期效果外，报销限制可能会产生意想不到的影响，例如患者放弃治疗，这可能导致健康问题并增加医疗保健的使用。报销限制的一个例子是质子泵抑制剂（PPI）的报销限制，该限制于2012年1月在荷兰生效。这项措施的一个主要意外后果可能是，开始使用非甾体抗炎药（NSAIDs）或低剂量阿司匹林（阿司匹林）且因胃并发症风险增加而被开PPI处方的高危患者会放弃这种PPI治疗。本研究的目的是评估报销限制对NSAIDs或阿司匹林高危使用者的影响。这些患者是否会放弃PPI治疗，如果是，他们发生胃并发症的风险是否会增加？部分开始使用NSAIDs或阿司匹林的患者由于年龄、合并症或联合用药而发生胃并发症的风险增加。比较了报销限制前两年（2010年和2011年）和报销限制实施后两年，使用NSAIDs或阿司匹林且发生胃并发症风险增加的患者使用PPI的情况。考虑了年龄、性别和社会经济地位（SES）的影响。在同一时期（2010 - 2013年）研究了因胃并发症导致的住院情况。数据来自一个基于人群的大型初级保健数据库和一个医院数据库。开始使用NSAID/阿司匹林且发生胃并发症风险增加的患者中，PPI的使用从2010年的40%增加到2013年的55%。未发现年龄、性别或SES有影响。报销限制后因胃并发症导致的住院人数没有增加。对PPI的报销限制与胃并发症风险增加的患者的任何可检测到的意外影响均无关联。
