抗癫痫药物的费用分担：药物利用和健康计划成本。

Cost sharing for antiepileptic drugs: medication utilization and health plan costs.

机构信息

Brown University School of Public Health, Box G-S121-6, 121 South Main St, Providence, RI 02198. Email:

出版信息

Am J Manag Care. 2018 Jun 1;24(6):e183-e189.

Abstract

OBJECTIVES

To examine the association between health plan out-of-pocket (OOP) costs for antiepileptic drugs and healthcare utilization (HCU) and overall plan spending among US-based commercial health plan beneficiaries with epilepsy.

STUDY DESIGN

Retrospective cohort.

METHODS

The Truven MarketScan Commercial Claims database for January 1, 2009, to June 30, 2015, was used. Patients 65 years or younger with epilepsy and at least 12 months of continuous enrollment before index (date meeting first epilepsy diagnostic criteria) were included. Analyses were adjusted for age group, gender, beneficiary relationship, insurance plan type, and Charlson Comorbidity Index score. Primary outcomes included proportion of days covered (PDC), HCU, and healthcare spending in 90-day postindex periods. Associations between OOP costs and mean PDC, HCU, and plan healthcare spending per 90-day period were estimated.

RESULTS

Across 5159 plans, 187,241 beneficiaries met eligibility criteria; 54.3% were female, 41.7% were aged 45 to 65 years, and 62.4% were in preferred provider organization plans. Across postindex 90-day periods, mean (SD) PDC, epilepsy-specific hospitalizations, outpatient visits, and emergency department visits were 0.85 (0.26), 0.02 (0.13), 0.34 (0.47), and 0.05 (0.22), respectively. Median (interquartile range) spending per 90-day period was $1488 ($459-$4705); median epilepsy-specific spending was $139 ($18-$623). Multivariable linear regression without health plan fixed effects revealed that higher OOP spending was associated with a decrease in PDC (coefficient, -0.008; 95% CI, -0.009 to -0.006; P <.001) and an increase in overall spending (218.6; 95% CI, 47.9-389.2; P = .012). Health plan fixed effects model estimates were similar, except for epilepsy-specific spending, which was significant (120.6; 95% CI, 29.2-211.9; P = .010).

CONCLUSIONS

Increases in beneficiaries' OOP costs led to higher overall spending and lower PDC.

摘要

目的

研究美国商业健康计划受益人群中抗癫痫药物的自付费用（OOP）与医疗保健利用（HCU）和整体计划支出之间的关系。

研究设计

回顾性队列研究。

方法

使用 Truven MarketScan 商业索赔数据库，时间范围为 2009 年 1 月 1 日至 2015 年 6 月 30 日。纳入年龄在 65 岁及以下、在索引日期（首次满足癫痫诊断标准的日期）前至少 12 个月连续入组的癫痫患者。分析中调整了年龄组、性别、受益人与保险人的关系、保险计划类型和 Charlson 合并症指数评分。主要结局指标包括 90 天索引后期间的天数覆盖率（PDC）、HCU 和每 90 天的医疗保健支出。估计 OOP 成本与平均 PDC、HCU 和每 90 天计划医疗保健支出之间的关系。

结果

在 5159 个计划中，有 187241 名符合资格标准的患者；54.3%为女性，41.7%年龄在 45 至 65 岁之间，62.4%为首选提供者组织计划。在索引后的 90 天期间，平均（SD）PDC、癫痫特定住院治疗、门诊就诊和急诊就诊分别为 0.85（0.26）、0.02（0.13）、0.34（0.47）和 0.05（0.22）。每 90 天的中位数（四分位距）支出为 1488 美元（459-4705 美元）；中位数癫痫特定支出为 139 美元（18-623 美元）。没有健康计划固定效应的多变量线性回归显示，OOP 支出增加与 PDC 降低相关（系数，-0.008；95%置信区间，-0.009 至-0.006；P <.001），与整体支出增加相关（218.6；95%置信区间，47.9-389.2；P =.012）。健康计划固定效应模型的估计值相似，除了癫痫特定支出有显著意义（120.6；95%置信区间，29.2-211.9；P =.010）。