O Neill Kate N, Bennett Kathleen E, Mc Hugh Sheena M, Fitzgerald Anthony P, Kearney Patricia M
School of Public Health, University College Cork, Cork, Ireland
Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
BMJ Open. 2020 Oct 10;10(10):e037382. doi: 10.1136/bmjopen-2020-037382.
To explore trends in pharmaceutical expenditure on diabetes between 2011 and 2015, describing trends in expenditure on blood glucose-lowering medications and estimating the effect of cost-containment measures implemented during this time.
Repeated cross-sectional study of national pharmacy claims data in Ireland.
Patients' dispensed items used in the treatment or management of diabetes.
Total expenditure associated with diabetes was calculated by extracting data on all diabetes-related items dispensed to eligible patients. Costs were categorised into two groups. Diabetes-specific items include items used directly in diabetes treatment (WHO-Anatomical Therapeutic Chemical (ATC): A10, V07, V04) and diabetes-related include all other condition-related items (WHO-ATC: B01, C, H04, N03, N06). The impacts of two specific cost-containment measures, co-payments and reference pricing, were assessed using segmented linear regression analyses of interrupted time-series.
Total expenditure varied over the study period, peaking at €216 994 441 in 2012. Expenditure on diabetes-specific items increased steadily by 18% reaching €153 621 477 in 2015, with blood glucose-lowering medications accounting for 73% of this increase. During the same period, expenditure on diabetes-related items decreased by 32% to €50 835 856. The introduction of reference pricing for atorvastatin in November 2013 resulted in immediate costs savings of €2.4 million per yearly quarter (level-change p<0.001).
The increasing expenditure on blood glucose-lowering medications negates the effect of recent cost-containment measures, presenting a significant challenge for the provision of diabetes care. Innovative policies are required to ensure high-quality diabetes care can be provided at an equitable, affordable and sustainable rate.
探讨2011年至2015年糖尿病药物支出趋势，描述降糖药物支出趋势，并估算在此期间实施的成本控制措施的效果。
对爱尔兰国家药房报销数据进行重复横断面研究。
用于糖尿病治疗或管理的患者配药项目。
通过提取发放给符合条件患者的所有糖尿病相关项目的数据，计算与糖尿病相关的总支出。成本分为两组。糖尿病特定项目包括直接用于糖尿病治疗的项目（世界卫生组织解剖治疗化学分类（ATC）：A10、V07、V04），糖尿病相关项目包括所有其他疾病相关项目（世界卫生组织ATC：B01、C、H04、N03、N06）。使用中断时间序列的分段线性回归分析评估两项特定成本控制措施（共付额和参考定价）的影响。
在研究期间总支出有所变化，2012年达到峰值216994441欧元。糖尿病特定项目的支出稳步增长18%，2015年达到153621477欧元，其中降糖药物占这一增长的73%。同期，糖尿病相关项目的支出下降了32%，降至50835856欧元。2013年11月引入阿托伐他汀参考定价后，每季度立即节省成本240万欧元（水平变化p<0.001）。
降糖药物支出的增加抵消了近期成本控制措施的效果，给糖尿病护理带来了重大挑战。需要创新政策，以确保能够以公平、可承受和可持续的费率提供高质量的糖尿病护理。
