Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia.
School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Int J Popul Data Sci. 2021 Apr 15;6(1):1418. doi: 10.23889/ijpds.v6i1.1418.
A wealth of data is generated through Australia's universal health care arrangements. However, use of these data has been hampered by different federal and state legislation, privacy concerns and challenges in linking data across jurisdictions. A series of data reforms have been touted to increase population health research capacity in Australia, including pharmacoepidemiology research. Here we catalogued research leveraging Australia's Pharmaceutical Benefits Scheme (PBS) data (2014-2018) and discussed these outputs in the context of previously implemented and new data reforms.
We conducted a systematic review of population-based studies using PBS dispensing claims. Independent reviewers screened abstracts of 4,996 articles and 310 full-text manuscripts. We characterised publications according to study population, analytical approach, data sources used, aims and medicines focus.
We identified 180 studies; 133 used individual-level data, 70 linked PBS dispensing claims with other health data (66 across jurisdictions). Studies using individual-level data focussed on Australians receiving government benefits (87 studies) rather than all PBS-eligible persons. 63 studies examined clinician or patient practices and 33 examined exposure-outcome relationships (27 evaluated medicines safety, 6 evaluated effectiveness). Medicines acting on the nervous and cardiovascular system account for the greatest volume of PBS medicines dispensed and were the most commonly studied (67 and 40 studies, respectively). Antineoplastic and immunomodulating agents account for approximately one third of PBS expenditure but represented only 10% of studies in this review.
The studies in this review represent more than a third of all population-based pharmacoepidemiology research published in the last three decades in Australia. Recent data reforms have contributed to this escalating output. However, studies are concentrated among specific subpopulations and medicines classes, and there remains a limited understanding of population benefits and harms derived from medicines use. The current draft Data Availability and Transparency legislation should further bolster efforts in population health research.
澳大利亚的全民医疗保健安排产生了大量数据。然而，由于不同的联邦和州立法、隐私问题以及跨司法管辖区数据链接的挑战，这些数据的使用受到了阻碍。为了提高澳大利亚的人口健康研究能力，包括药物流行病学研究，已经提出了一系列数据改革。在这里，我们列出了利用澳大利亚药品福利计划（PBS）数据（2014-2018 年）进行的研究，并根据之前实施的数据改革和新数据改革讨论了这些研究结果。
我们对使用 PBS 配药记录的基于人群的研究进行了系统评价。独立评审员筛选了 4996 篇文章和 310 篇全文手稿的摘要。我们根据研究人群、分析方法、使用的数据来源、目的和药物重点对出版物进行了分类。
我们确定了 180 项研究；133 项使用了个体层面的数据，70 项将 PBS 配药记录与其他健康数据（66 项在司法管辖区之间）进行了关联。使用个体层面数据的研究集中在领取政府福利的澳大利亚人（87 项研究），而不是所有符合 PBS 条件的人。63 项研究检查了临床医生或患者的实践，33 项研究检查了暴露-结果关系（27 项评估了药物安全性，6 项评估了疗效）。作用于神经系统和心血管系统的药物占 PBS 配药量最大，也是最常研究的药物（分别为 67 项和 40 项研究）。抗肿瘤和免疫调节药物占 PBS 支出的三分之一左右，但在本综述中的研究仅占 10%。
本综述中的研究代表了过去 30 年在澳大利亚发表的所有基于人群的药物流行病学研究的三分之一以上。最近的数据改革促成了这一不断增加的产出。然而，研究集中在特定的亚人群和药物类别，对药物使用带来的人群效益和危害的认识仍然有限。当前的数据可用性和透明度立法草案应进一步加强人口健康研究的努力。
