Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut.
Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California.
Ophthalmology. 2020 Oct;127(10):1292-1302. doi: 10.1016/j.ophtha.2020.04.037. Epub 2020 Apr 28.
To estimate temporal trends in total and out-of-pocket (OOP) expenditures for ophthalmic prescription medications among adults in the United States.
Retrospective, longitudinal cohort study.
Participants in the 2007 through 2016 Medical Expenditure Panel Survey (MEPS) 18 years of age or older. The MEPS is a nationally representative survey of the noninstitutionalized, civilian United States population.
We estimated trends in national and per capita annual ophthalmic prescription expenditures by pooling data into 2-year cycles and using weighted linear regressions. We also identified characteristics associated with greater total or OOP expenditures with multivariate weighted linear regression. Costs were adjusted to 2016 United States dollars using the gross domestic product price index.
Trends in total and OOP annual expenditures for ophthalmic medications from 2007 through 2016 as well as factors associated with greater expenditures.
From 2007 through 2016, 9989 MEPS participants (4.2%) reported ophthalmic medication prescription use. Annual ophthalmic medication use increased from 10.0 to 12.2 million individuals from 2007 and 2008 through 2015 and 2016. In this same period, national expenditures for ophthalmic medications increased from $3.39 billion to $6.08 billion and OOP expenditures decreased from $1.34 to $1.18 billion. Per capita expenditure increased from $338.72 to $499.42 (P < 0.001), and per capita OOP expenditure decreased from $133.48 to $96.67 (P < 0.001) from 2007 and 2008 through 2015 and 2016, respectively. From 2015 through 2016, dry eye (29.5%) and glaucoma (42.7%) medications accounted for 72.2% of all ophthalmic medication expenditures. Patients who were older than 65 years (P < 0.001), uninsured (P < 0.001), and visually impaired (P < 0.001) were significantly more likely to have greater OOP spending on ophthalmic medications.
Total ophthalmic medication expenditure in the United States increased significantly over the last decade, whereas OOP expenses decreased. Increases in coverage, copayment assistance, and use of expensive brand drugs may be contributing to these trends. Policy makers and physicians should be aware that rising overall drug expenditures ultimately may increase indirect costs to the patient and offset a decline in OOP prescription drug spending.
评估美国成年人眼科处方药物的总支出和自付支出（OOP）的时间趋势。
回顾性、纵向队列研究。
2007 年至 2016 年医疗支出调查（MEPS）中年龄在 18 岁或以上的参与者。MEPS 是对美国非机构化、平民人口的全国代表性调查。
我们通过将数据汇总为两年周期并使用加权线性回归来估计全国和人均年度眼科处方支出的趋势。我们还使用多元加权线性回归来确定与总支出或 OOP 支出较高相关的特征。使用国内生产总值价格指数将成本调整为 2016 年的美元。
2007 年至 2016 年眼科药物的总支出和 OOP 年度支出趋势，以及与较高支出相关的因素。
从 2007 年至 2016 年，9989 名 MEPS 参与者（4.2%）报告了眼科药物处方使用情况。从 2007 年和 2008 年到 2015 年和 2016 年，眼科药物的年使用量从 1000 万增加到 1220 万。在同一时期，眼科药物的国家支出从 33.9 亿美元增加到 60.8 亿美元，OOP 支出从 13.4 亿美元减少到 11.8 亿美元。人均支出从 338.72 美元增加到 499.42 美元（P<0.001），人均 OOP 支出从 2007 年和 2008 年到 2015 年和 2016 年分别从 133.48 美元减少到 96.67 美元（P<0.001）。从 2015 年到 2016 年，干眼症（29.5%）和青光眼（42.7%）药物占所有眼科药物支出的 72.2%。年龄大于 65 岁的患者（P<0.001）、没有保险的患者（P<0.001）和视力受损的患者（P<0.001）在眼科药物 OOP 支出方面更有可能显著增加。
在过去十年中，美国的眼科药物总支出显著增加，而 OOP 支出减少。覆盖范围的扩大、共同支付援助和昂贵品牌药物的使用可能是导致这些趋势的原因。政策制定者和医生应该意识到，不断上升的整体药物支出最终可能会增加患者的间接成本，并抵消 OOP 处方药支出的下降。
