Stoker Lennart Jan, Heerdink Eibert Roelof, Janssen Richard, Egberts Toine C G
Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
Clinical Pharmacy, Medisch Centrum Haaglanden, Den Haag, Zuid-Holland, The Netherlands.
BMJ Open. 2019 Sep 24;9(9):e029148. doi: 10.1136/bmjopen-2019-029148.
Use of benzodiazepines has health risks. Reimbursement was restricted in the Netherlands from January 2009 onwards with the goal to reduce chronic use and healthcare expenditures. The aim of this study is to assess the initial and long-term effects of this policy on benzodiazepine use.
Interrupted time series analysis, segmented regression models, Kaplan-Meier survival analysis and Cox proportional hazards analysis.
A 10% random sample of benzodiazepine dispensings by outpatient pharmacies between January 2002 and August 2015 were obtained from the PHARMO database. This database covered a catchment area representing about 3.6 million residents in 2015.
2 500 800 benzodiazepine prescriptions from 128 603 patients were included.
Reimbursement restriction policy from January 2009 onwards.
Changes in: the volume of dispensed prescriptions and doses, the incidence, prevalence of incidental, regular and chronic use and discontinuation rates of benzodiazepines.
The volume of dispensed prescriptions and doses decreased by 12.5% (95% CI 9.0% to 15.9%) and 15.1% (95% CI 11.4% to 17.3%) respectively in January 2009 compared with December 2008. A clear initial effect on the overall incidence (-14.7%; 95% CI -19.8% to 9.6%) and the prevalence of incidental (-17.8%; 95% CI -23.9% to 11.7%), regular (-20.0%; 95% CI -26.1% to 13.9%) and chronic (-16.0%; 95% CI -23.1% to 8.9%) use was observed. A statistically significant reduction in the monthly trend per 1000 medication users was observed for the overall incidence (-0.017; 95% CI -0.031 to 0.003) and the prevalence of incidental (-3.624; 95% CI -4.996 to 2.252) but not for regular (-0.304; 95% CI -1.204 to 0.596) and chronic (0.136; 95% CI -0.858 to 1.130) use. Patients who started treatment before policy had a slightly higher probability of discontinuation (HR=1.013; 95% CI 1.004 to 1.022).
The reimbursement policy had a significant initial effect on the volume, incidence and prevalence of benzodiazepine use. In addition, there is a statistically significant reduction in the monthly trend of overall incidence and of the prevalence of incidental use. No statistically significant reduction in the monthly trend of chronic use, the main purpose of the reimbursement restriction, could be demonstrated.
使用苯二氮䓬类药物存在健康风险。自2009年1月起，荷兰对苯二氮䓬类药物的报销进行了限制，目的是减少长期使用和医疗保健支出。本研究的目的是评估该政策对苯二氮䓬类药物使用的初始和长期影响。
中断时间序列分析、分段回归模型、Kaplan-Meier生存分析和Cox比例风险分析。
从PHARMO数据库中获取2002年1月至2015年8月期间门诊药房10%的苯二氮䓬类药物配药随机样本。该数据库覆盖的集水区在2015年约有360万居民。
纳入了128603名患者的2500800份苯二氮䓬类药物处方。
自2009年1月起实施报销限制政策。
以下方面的变化：配药处方量和剂量、苯二氮䓬类药物偶然使用、经常使用和长期使用的发生率、患病率及停药率。
与2008年12月相比，2009年1月配药处方量和剂量分别下降了12.5%（95%CI 9.0%至15.9%）和15.1%（95%CI 11.4%至17.3%）。观察到对总体发生率（-14.7%；95%CI -19.8%至9.6%）以及偶然使用（-17.8%；95%CI -23.9%至11.7%）、经常使用（-20.0%；95%CI -26.1%至13.9%）和长期使用（-16.0%；95%CI -23.1%至8.9%）的患病率有明显的初始影响。观察到每1000名用药者总体发生率（-0.017；95%CI -0.031至0.003）和偶然使用患病率（-3.624；95%CI -4.996至2.252）的每月趋势有统计学显著降低，但经常使用（-0.304；95%CI -1.204至0.596）和长期使用（0.136；95%CI -0.858至1.130）的每月趋势没有降低。在政策实施前开始治疗的患者停药概率略高（HR = 1.013；95%CI 1.004至1.022）。
报销政策对苯二氮䓬类药物的使用量、发生率和患病率有显著的初始影响。此外，总体发生率和偶然使用患病率的每月趋势有统计学显著降低。未能证明作为报销限制主要目的的长期使用每月趋势有统计学显著降低。
