Kadiyala Srikanth, Chenoweth Matthew, Watanabe Jonathan H
UCLA Center for Health Policy Research, UCLA Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA 90024, United States.
UCLA Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA 90024, United States.
Health Aff Sch. 2025 Jun 11;3(7):qxaf114. doi: 10.1093/haschl/qxaf114. eCollection 2025 Jul.
Off-label prescribing-when medications are used for indications not approved by the Food and Drug Administration-is widespread in the US health care system. This study used trazodone, a drug approved in 1981 for depression, as a case study to examine broader issues surrounding off-label utilization and spending. Although only approved to treat depression, trazodone is frequently prescribed off-label for indications of uncertain clinical value (insomnia, anxiety). Using nationally representative data from the Medical Expenditure Panel Survey, we estimated that approximately 24 million trazodone prescriptions were filled in 2019, with health care spending of $294 million. At least 85% of prescriptions (∼20 million) and 84% of spending ($247 million) were for off-label indications, primarily insomnia. Health plan reimbursement per prescription was nearly identical for on-label and off-label use, despite the significant evidence gap. These findings illustrate the scale and inefficiency of off-label prescribing and highlight challenges facing clinicians, patients, and payers. We propose a set of policy solutions-including public and private investment in evidence generation, pricing drugs to account for off-label use, and value-based reimbursement-to advance a more efficient system of off-label use. Trazodone presents a revealing case of the broader systemic problem of off-label prescribing for indications of uncertain clinical value.
药品用于食品药品监督管理局未批准的适应症,即超说明书用药,在美国医疗保健系统中很普遍。本研究以1981年获批用于治疗抑郁症的曲唑酮为例,探讨超说明书用药及费用支出等更广泛的问题。尽管曲唑酮仅获批用于治疗抑郁症,但它经常被超说明书开出处方,用于临床价值不确定的适应症(失眠、焦虑)。利用医疗支出面板调查的全国代表性数据,我们估计2019年大约开出了2400万张曲唑酮处方,医疗保健支出达2.94亿美元。至少85%的处方(约2000万张)和84%的支出(2.47亿美元)用于超说明书适应症,主要是失眠。尽管有明显的证据差距,但超说明书用药和按说明书用药的每张处方医保报销金额几乎相同。这些发现说明了超说明书用药的规模和低效性,并凸显了临床医生、患者和支付方面临的挑战。我们提出了一套政策解决方案,包括公共和私人对证据生成的投资、根据超说明书用药情况定价药品以及基于价值的报销,以推动建立一个更高效的超说明书用药系统。曲唑酮揭示了超说明书用于临床价值不确定适应症这一更广泛系统性问题的典型案例。