Department of Psychiatry, National Health Insurance Service Ilsan Hospital, Goyang, South Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, South Korea.
Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang, South Korea.
J Psychiatr Res. 2019 Nov;118:31-37. doi: 10.1016/j.jpsychires.2019.08.010. Epub 2019 Aug 22.
The cost-effectiveness of both cholinesterase inhibitors and memantine by delaying nursing home placement has been supported by numerous studies. The importance of sustained pharmacological treatment in dementia has been relatively less recognized by public health policies compared to early diagnosis. We investigated the effect of the drug (donepezil, rivastigmine, galantamine, and memantine) compliance on the health care costs in newly-diagnosed dementia.
National Health Insurance Service (NHIS) database which covers the entire population of South Korea was used for analysis. Health care expenditure of patients newly-diagnosed with dementia in between 2012 and 2014 was investigated for 3-5 years. For drug compliance, we used Medication Possession Ratio (MPR) that indicates the percentage of time a patient has access to medication. Multivariate linear regression analysis including generalized estimated equation and gamma distribution was used for statistical analysis.
We identified 252,594 patients who were both prescribed with cognitive enhancers and newly diagnosed with dementia. When initial MPR increased 20%, total health care costs decreased 8.4% (RR = 0.916, 95%; CI 0.914 to 0.916). Same relationship was shown with medical costs related to dementia, admission to a general hospital, and emergency room visits. When MPR increased 20% compared to the previous year, the total health care costs, admission to a general hospital, emergency room visits, and admission to a nursing hospital decreased.
This population-based retrospective cohort study provides evidence that patients newly-diagnosed with dementia who showed higher initial drug compliance or maintained antidementia drugs (Cholinesterase inhibitors and memantine) would benefit in total health-care costs.
许多研究都证实了胆碱酯酶抑制剂和美金刚通过延缓入住养老院的时间具有成本效益。与早期诊断相比，公众健康政策相对较少认识到痴呆症持续药物治疗的重要性。我们研究了药物（多奈哌齐、卡巴拉汀、加兰他敏和美金刚）依从性对新诊断痴呆患者医疗保健费用的影响。
我们使用了涵盖韩国全部人口的国家健康保险服务（NHIS）数据库进行分析。对 2012 年至 2014 年间新诊断为痴呆症的患者在 3 至 5 年内的医疗支出进行了调查。药物依从性我们使用药物使用比例（MPR）来表示患者有机会使用药物的时间百分比。采用广义估计方程和伽马分布的多变量线性回归分析进行了统计分析。
我们确定了 252594 名同时开具认知增强剂和新诊断为痴呆症的患者。当初始 MPR 增加 20%时，总医疗费用降低 8.4%（RR=0.916，95%；CI 0.914 至 0.916）。与痴呆相关的医疗费用、住院、急诊就诊也存在同样的关系。与前一年相比，当 MPR 增加 20%时，总医疗费用、住院、急诊就诊和入住疗养院的费用都降低了。
这项基于人群的回顾性队列研究提供了证据表明，新诊断为痴呆症的患者，如果初始药物依从性较高或持续使用抗痴呆药物（胆碱酯酶抑制剂和美金刚），则在总医疗保健费用方面将受益。
