免费药品分发对加拿大 3 年医疗费用的影响：CLEAN Meds 随机临床试验的二次分析。
Effect of Free Medicine Distribution on Health Care Costs in Canada Over 3 Years: A Secondary Analysis of the CLEAN Meds Randomized Clinical Trial.
机构信息
Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
出版信息
JAMA Health Forum. 2023 May 5;4(5):e231127. doi: 10.1001/jamahealthforum.2023.1127.
IMPORTANCE
Few interventions are proven to reduce total health care costs, and addressing cost-related nonadherence has the potential to do so.
OBJECTIVE
To determine the effect of eliminating out-of-pocket medication fees on total health care costs.
DESIGN, SETTING, AND PARTICIPANTS: This secondary analysis of a multicenter randomized clinical trial using a prespecified outcome took place across 9 primary care sites in Ontario, Canada (6 in Toronto and 3 in rural areas), where health care services are generally publicly funded. Adult patients (≥18 years old) reporting cost-related nonadherence to medicines in the past 12 months were recruited between June 1, 2016, and April 28, 2017, and followed up until April 28, 2020. Data analysis was completed in 2021.
INTERVENTIONS
Access to a comprehensive list of 128 medicines commonly prescribed in ambulatory care with no out-of-pocket costs for 3 years vs usual medicine access.
MAIN OUTCOME AND MEASURES
Total publicly funded health care costs over 3 years, including costs of hospitalizations. Health care costs were determined using administrative data from Ontario's single-payer health care system, and all costs are reported in Canadian dollars with adjustments for inflation.
RESULTS
A total of 747 participants from 9 primary care sites were included in the analysis (mean [SD] age, 51 [14] years; 421 [56.4%] female). Free medicine distribution was associated with a lower median total health care spending over 3 years of $1641 (95% CI, $454-$2792; P = .006). Mean total spending was $4465 (95% CI, -$944 to $9874) lower over the 3-year period.
CONCLUSIONS AND RELEVANCE
In this secondary analysis of a randomized clinical trial, eliminating out-of-pocket medication expenses for patients with cost-related nonadherence in primary care was associated with lower health care spending over 3 years. These findings suggest that eliminating out-of-pocket medication costs for patients could reduce overall costs of health care.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT02744963.
重要性
很少有干预措施被证明可以降低总体医疗保健成本，而解决与费用相关的不依从性则有可能降低总体医疗保健成本。
目的
确定消除自付药物费用对总体医疗保健成本的影响。
设计、地点和参与者：这是一项多中心随机临床试验的二次分析，采用了预先指定的结果，在加拿大安大略省的 9 个初级保健点进行（多伦多 6 个，农村地区 3 个），那里的医疗服务通常是由公共资金资助的。在过去 12 个月内报告因药物费用相关而不遵医嘱的成年患者（≥18 岁）于 2016 年 6 月 1 日至 2017 年 4 月 28 日招募，并随访至 2020 年 4 月 28 日。数据分析于 2021 年完成。
干预措施
提供一份 128 种常见的门诊处方药物清单，患者在 3 年内无需支付自付费用，而不是通常的药物获取方式。
主要结果和测量指标
3 年内的总公共资助医疗保健费用，包括住院费用。医疗保健费用是使用安大略省单一支付者医疗保健系统的行政数据确定的，所有费用均以加元报告，并进行了通胀调整。
结果
共纳入 9 个初级保健点的 747 名参与者（平均[标准差]年龄 51[14]岁；421[56.4%]为女性）。免费药物分发与 3 年内中位数总医疗保健支出降低 1641 加元（95% CI，454-2792 加元；P = .006）相关。在 3 年期间，平均总支出减少了 4465 加元（95% CI，-944 至 9874 加元）。
结论和相关性
在这项随机临床试验的二次分析中，在初级保健中消除与费用相关的不遵医嘱患者的自付药物费用与 3 年内较低的医疗保健支出相关。这些发现表明，为患者消除自付药物费用可能会降低整体医疗保健成本。
试验注册
ClinicalTrials.gov 标识符：NCT02744963。
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