Yue Xiaomeng, Guo Jeff Jianfei, Wigle Patricia R
PhD Student, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, OH.
Professor of Pharmacoeconomics & Pharmacoepidemiology, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, OH.
Am Health Drug Benefits. 2018 Sep;11(6):275-285.
Smoking remains the single largest preventable cause of death and disease. Smoking-cessation medications provide patients a multitude of benefits and can prevent certain diseases, including some cancers. Because of the limited amount of studies on smoking-cessation medications, we wanted to find general trends about the use of these medications.
To examine trends in the utilization, pharmacy reimbursement, and prices of smoking-cessation medications and nicotine replacement therapy in the US Medicaid-covered population.
Using national summary files for outpatient drug utilization and expenditure, we extracted data on smoking-cessation medications from the Centers for Medicare & Medicaid Services in the 25 years from January 1991 through June 2015. We conducted a retrospective drug utilization study to examine the annual (or quarterly) trends of the number of prescriptions, reimbursement expenditures, and the prices of smoking-cessation medications. The study drugs included varenicline (Chantix), bupropion (Zyban), and nicotine. We calculated per-prescription pharmacy reimbursement, which was used as a proxy for drug price, as the total quarterly expenditure for the drug, divided by the total number of prescriptions. All expenditures were inflated to 2015 US dollars using the medical services component of the Consumer Price Index.
The total number of prescriptions for smoking-cessation medications increased rapidly from 46,396 in 1991 to 942,562 in 2014, an increase of more than 1931%. During the same period, the total pharmacy reimbursement for smoking-cessation medications in Medicaid increased by 3562%, from approximately $2.8 million in 1991 to approximately $101 million in 2014. The use of the nonnicotine prescription drugs varenicline and bupropion also increased rapidly, with a high cost expenditure. The price per nonnicotine prescription drug increased over time, ranging from approximately $169 for bupropion to approximately $251 for varenicline in 2015.
The substantial increase in nonnicotine prescription drugs and nicotine replacement therapy between 2007 and 2015 may be attributed to smoking-cessation participants nationwide. Cost-containment policies might have inadvertently prevented Medicaid-covered smokers from obtaining appropriate pharmacotherapy.
吸烟仍然是单一最大的可预防死亡和疾病原因。戒烟药物能为患者带来诸多益处，并可预防某些疾病，包括一些癌症。由于关于戒烟药物的研究数量有限，我们希望找出这些药物使用的总体趋势。
研究美国医疗补助覆盖人群中戒烟药物及尼古丁替代疗法的使用、药房报销和价格趋势。
利用门诊药物使用和支出的全国汇总文件，我们从医疗保险和医疗补助服务中心提取了1991年1月至2015年6月这25年间的戒烟药物数据。我们进行了一项回顾性药物使用研究，以考察戒烟药物处方数量、报销支出和价格的年度（或季度）趋势。研究药物包括伐尼克兰（畅沛）、安非他酮（载班）和尼古丁。我们计算了每张处方的药房报销费用，将其作为药物价格的替代指标，计算方法是该药物的季度总支出除以处方总数。所有支出都使用消费者价格指数的医疗服务部分将其换算为2015年美元。
戒烟药物的处方总数从1991年的46396张迅速增加到2014年的942562张，增长超过1931%。同期，医疗补助中戒烟药物的药房报销总额增长了3562%，从1991年的约280万美元增至2014年的约1.01亿美元。非尼古丁处方药伐尼克兰和安非他酮的使用也迅速增加，成本支出较高。非尼古丁处方药的单价随时间上涨，2015年安非他酮约为169美元，伐尼克兰约为251美元。
2007年至2015年间非尼古丁处方药和尼古丁替代疗法的大幅增加可能归因于全国范围内的戒烟参与者。成本控制政策可能无意中阻碍了医疗补助覆盖的吸烟者获得适当的药物治疗。
