在加拿大一项大型私人药物计划中引入药品目录的影响：中断时间序列分析
The impact of the introduction of a formulary into a large Canadian private drug plan: an interrupted time-series analysis.
作者信息
Cassels Alan, Law Michael R
机构信息
Faculty of Human and Social Development (Cassels, Law), University of Victoria, Victoria, BC; Centre for Health Services and Policy Research (Law), School of Population and Public Health, University of British Columbia, Vancouver, BC
Faculty of Human and Social Development (Cassels, Law), University of Victoria, Victoria, BC; Centre for Health Services and Policy Research (Law), School of Population and Public Health, University of British Columbia, Vancouver, BC.
出版信息
CMAJ Open. 2019 Jul 18;7(3):E472-E477. doi: 10.9778/cmajo.20180124. Print 2019 Jul-Sep.
BACKGROUND
Most private drug plans in Canada do not use a formulary, which leads to suboptimal drug use. We studied the impact of the adoption of the public formulary by a large private health benefits plan in British Columbia.
METHODS
We studied the impact of a change by members of the BC Hospital Employees' Union to have their private drug plan mirror the public formulary as of June 2013. With data from Pacific Blue Cross, we conducted a before-and-after descriptive study using interrupted time-series analysis to study changes in covered drug costs and use for 18 months preceding and following the change.
RESULTS
Our cohort averaged 66 000 plan members and dependents over our study period. Following the implementation of the formulary, the number of prescriptions covered by the plan declined by 0.46 prescriptions per member per month (95% confidence interval -0.50 to -0.42), a decline of 23.8% at 1 year. This decreased plan spending by $1.32 million over the 18 months after the coverage change, a 49.7% decline.
INTERPRETATION
The adoption of the public formulary by a large private drug plan in BC substantially reduced drug plan expenditures and the volume of prescriptions paid for by the plan. Overall, these results suggest that carefully designed formulary changes could substantially reduce spending by private-sector drug plans on drugs that have more cost-effective therapeutic alternatives.
背景
加拿大大多数私人药品计划不使用药品目录，这导致药品使用未达最佳状态。我们研究了不列颠哥伦比亚省一项大型私人健康福利计划采用公共药品目录的影响。
方法
我们研究了不列颠哥伦比亚省医院员工联盟成员自2013年6月起将其私人药品计划与公共药品目录保持一致这一变化的影响。利用太平洋蓝十字的数据，我们进行了一项前后描述性研究，采用中断时间序列分析来研究在这一变化前后18个月内承保药品成本和使用情况的变化。
结果
在我们的研究期间，我们的队列平均有66000名计划成员及其家属。药品目录实施后，该计划承保的处方数量下降至每位成员每月0.46张处方（95%置信区间为-0.50至-0.42），1年后下降了23.8%。在承保范围变更后的18个月内，这使计划支出减少了132万美元，降幅为49.7%。
解读
不列颠哥伦比亚省一项大型私人药品计划采用公共药品目录大幅降低了药品计划支出以及该计划支付的处方数量。总体而言，这些结果表明，精心设计的药品目录变更可大幅减少私营部门药品计划在有更具成本效益治疗替代方案的药品上的支出。
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