From the Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont St., Suite 3030, Boston, MA, 02120, USA.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont St., Suite 3030, Boston, MA, 02120, USA.
Drug Saf. 2020 Jul;43(7):669-675. doi: 10.1007/s40264-020-00923-6.
Clinical practice guidelines recommend co-prescribing naloxone to patients at high risk of opioid overdose, but few such patients receive naloxone. High costs of naloxone may contribute to limited dispensing.
The aim of this study was to evaluate rates and costs of dispensing naloxone to patients receiving opioid prescriptions and at high risk for opioid overdose.
Using claims data from a large US commercial insurance company, we conducted a retrospective cohort study of new opioid initiators between January 2014 and December 2018. We identified patients at high risk for overdose defined as a diagnosis of opioid use disorder, prior overdose, an opioid prescription of ≥ 50 mg morphine equivalents/day for ≥ 90 days, and/or concurrent benzodiazepine prescriptions.
Among 5,292,098 new opioid initiators, 616,444 (12%) met criteria for high risk of overdose during follow-up, and, of those, 3096 (0.5%) were dispensed naloxone. The average copayment was US$24.83 for naloxone (standard deviation [SD] 67.66) versus US$9.74 for the index opioid (SD 19.75). The average deductible was US$6.18 for naloxone (SD 27.32) versus US$3.74 for the index opioid (SD 25.56), with 94% and 88% having deductibles of US$0 for their naloxone and opioid prescriptions, respectively. The average out-of-pocket cost was US$31.01 for naloxone (SD 73.64) versus US$13.48 for the index opioid (SD 34.95).
Rates of dispensing naloxone to high risk patients were extremely low, and prescription costs varied greatly. Since improving naloxone's affordability may increase access, whether naloxone's high cost is associated with low dispensing rates should be evaluated.
临床实践指南建议为高阿片类药物过量风险的患者共同开纳洛酮处方，但很少有此类患者接受纳洛酮。纳洛酮成本高可能导致配药受限。
本研究旨在评估向接受阿片类药物处方和高阿片类药物过量风险的患者配纳洛酮的比例和成本。
利用一家大型美国商业保险公司的索赔数据，我们对 2014 年 1 月至 2018 年 12 月期间新开始使用阿片类药物的患者进行了回顾性队列研究。我们确定了高风险过量的患者，其定义为阿片类药物使用障碍的诊断、既往过量、阿片类药物处方≥50mg 吗啡当量/天≥90 天和/或同时开具苯二氮䓬类药物处方。
在 5292098 名新开始使用阿片类药物的患者中，616444 名（12%）在随访期间符合高风险过量标准，其中 3096 名（0.5%）开纳洛酮处方。纳洛酮的平均自付额为 24.83 美元（标准差 67.66），而阿片类药物的平均自付额为 9.74 美元（标准差 19.75）。纳洛酮的平均免赔额为 6.18 美元（标准差 27.32），阿片类药物的平均免赔额为 3.74 美元（标准差 25.56），分别有 94%和 88%的纳洛酮和阿片类药物处方免赔额为 0。纳洛酮的平均自费额为 31.01 美元（标准差 73.64），阿片类药物的平均自费额为 13.48 美元（标准差 34.95）。
向高风险患者开纳洛酮的比例极低，处方费用差异很大。由于提高纳洛酮的可负担性可能会增加获得机会，因此应评估纳洛酮的高成本是否与低配药率有关。
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