Auburn University Harrison School of Pharmacy, Auburn, AL, United States of America.
Indiana University School of Medicine, Indianapolis, IN, United States of America.
PLoS One. 2020 Apr 30;15(4):e0232226. doi: 10.1371/journal.pone.0232226. eCollection 2020.
To examine patterns of generic escitalopram initiation and substitution among Medicare beneficiaries.
This retrospective new user cohort used a 5% random sample of 2013-2015 Medicare administrative claims data. Fee-for-service Medicare beneficiaries continuously enrolled in Parts A, B, and D during a 6-month washout period prior to their initial generic or brand oral escitalopram prescriptions were included (n = 12,351). The primary outcomes were generic escitalopram treatment initiation, and among brand escitalopram initiators, generic substitution within 12 months. Patient demographics, health service utilization, and prescription level factors were measured and assessed.
Among all escitalopram initiators, about 88.2% Medicare beneficiaries initiated generic escitalopram. Beneficiaries who were younger age, male, residing in non-Northeast regions or urban area, in the Part D plan deductible benefit phase, and filling prescriptions at community/retail pharmacies were more likely to initiate generic treatment. Among brand escitalopram initiators (n = 1,464), about 20.7% switched to generic escitalopram, 31.2% switched to another alternative antidepressant, 25.1% discontinued treatment, and 8.7% were lost to follow up or passed away within 12 months after brand initiation. Factors associated with generic escitalopram substitution included region (Midwest vs. Northeast, adjusted hazard ratio (HR) = 1.46, 95% CI = 1.04-2.05), pre-index hospitalization (HR = 1.31; 95% CI = 1.16-1.48) and lower escitalopram average daily dosage (HR = 0.97; 95% CI = 0.95-0.99).
In 2013-2015, almost 90% Medicare beneficiaries initiated generic escitalopram treatment. Among brand escitalopram initiators, about 1 in 5 patients switched to generic escitalopram within 1 year, as compared to 1 in 4 or 1 in 3 who discontinued current or switched to alternative treatment, respectively. Medicare beneficiary's geographic region was independently associated with generic escitalopram initiation and substitution. Findings from this study not only provide up-to-date evidence in generic escitalopram use patterns among Medicare population, but also can guide educational and practice interventions to further increase generic escitalopram use.
研究医疗保险受益人群中依地普仑通用药物的起始使用和替代模式。
本回顾性新用户队列使用了 2013-2015 年医疗保险管理索赔数据的 5%随机样本。在初始通用或品牌口服依地普仑处方前的 6 个月洗脱期内，持续参加 A 部分、B 部分和 D 部分的医疗保险福利者（n=12351）被纳入研究。主要结局是通用依地普仑治疗的起始，以及品牌依地普仑起始者在 12 个月内的通用替代。测量并评估了患者人口统计学、卫生服务利用和处方水平因素。
在所有依地普仑起始者中，约 88.2%的医疗保险受益人群起始了通用依地普仑治疗。年龄较小、男性、居住在非东北部地区或城市地区、处于部分 D 计划免赔额福利阶段、在社区/零售药店配药的受益人群更可能起始通用治疗。在品牌依地普仑起始者（n=1464）中，约 20.7%的人转为使用通用依地普仑，31.2%的人转为使用其他替代抗抑郁药，25.1%的人停止治疗，8.7%的人在品牌起始后 12 个月内失访或死亡。与通用依地普仑替代相关的因素包括地区（中西部与东北部，调整后的风险比（HR）=1.46，95%可信区间（CI）=1.04-2.05）、指数前住院治疗（HR=1.31；95%CI=1.16-1.48）和较低的依地普仑平均日剂量（HR=0.97；95%CI=0.95-0.99）。
在 2013-2015 年，近 90%的医疗保险受益人群起始了通用依地普仑治疗。在品牌依地普仑起始者中，约有 1/5 的患者在 1 年内转为使用通用依地普仑，而 1/4 或 1/3 的患者分别停止当前治疗或转为其他替代治疗。医疗保险受益人群的地理位置与通用依地普仑的起始使用和替代独立相关。本研究结果不仅提供了医疗保险人群中通用依地普仑使用模式的最新证据，而且还可以指导教育和实践干预措施，以进一步增加通用依地普仑的使用。
