Powe N R, Griffiths R I, Anderson G F, de Lissovoy G, Watson A J, Greer J W, Herbert R J, Whelton P K
Division of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Am J Kidney Dis. 1993 Oct;22(4):557-67. doi: 10.1016/s0272-6386(12)80929-2.
The Medicare payment policy for recombinant human erythropoietin (rHuEPO) treatment for dialysis patients changed in January 1991 from a relatively fixed payment per treatment (allowed charge of $40 per < or = 10,000 units injected) to a more variable payment based on the amount of rHuEPO administered with each treatment (allowed charge of $11 per 1,000 units injected). This change provided an opportunity to examine how payment policy can effect the use, cost, and health outcome of a biotechnology product used in the dialysis population. In cross-sectional (n = 71,880 Medicare-entitled dialysis patients) and longitudinal (n = 29,088 Medicare-entitled dialysis patients) study designs, we used Medicare end-stage renal disease program and claims data in bivariate and multivariate analyses to examine the effect of the change in payment policy for rHuEPO on access to the biotechnology, dosing, costs, and hematocrit, including the prescribing patterns at for-profit versus not-for-profit providers. The observation period included several months before (July 1989 to December 1990) and 6 months after (January to June 1991) the change in Medicare payment policy. The mean dose per treatment during the initial and fourth month of therapy was low (2,742 [95% confidence interval, 2,703 to 2,781] units and 2,632 [95% confidence interval, 2,598 to 2,667] units, respectively, in June 1990) and increased 3.4% and 5.0%, respectively, in the next 6 months prior to the change in Medicare payment policy compared with 14.6% and 14.8%, respectively, in the 6 months following the change in payment policy. The average monthly allowed charge for rHuEPO per dialysis patient receiving rHuEPO decreased from $455 before the policy change to $349 immediately following the policy change, because the allowed charge per unit of rHuEPO was lower when payment became more dependent on the amount of rHuEPO administered with each treatment than when the payment was fixed at $40 per treatment. The average monthly allowed charge for rHuEPO increased to $375 in the sixth month following the change in payment policy as a result of the increase in dose and the new variable payment. The unadjusted and adjusted changes in mean hematocrit 6 months after the payment change were positive but clinically very small (0.3 and 0.2 percentage points, respectively).(ABSTRACT TRUNCATED AT 400 WORDS)
1991年1月，医疗保险针对透析患者使用重组人促红细胞生成素（rHuEPO）的支付政策发生了变化，从相对固定的每次治疗支付（每注射≤10,000单位允许收费40美元）转变为根据每次治疗使用的rHuEPO量进行更具变化性的支付（每注射1,000单位允许收费11美元）。这一变化提供了一个机会，来研究支付政策如何影响透析人群使用的一种生物技术产品的使用情况、成本和健康结果。在横断面研究（n = 71,880名符合医疗保险条件的透析患者）和纵向研究（n = 29,088名符合医疗保险条件的透析患者）设计中，我们在双变量和多变量分析中使用了医疗保险终末期肾病项目和理赔数据，以研究rHuEPO支付政策的变化对获取该生物技术产品、给药剂量、成本和血细胞比容的影响，包括营利性与非营利性提供者的处方模式。观察期包括医疗保险支付政策变化前的几个月（1989年7月至1990年12月）和变化后的6个月（1991年1月至6月）。治疗初始月和第4个月的每次治疗平均剂量较低（1990年6月分别为2,742 [95%置信区间，2,703至2,781]单位和2,632 [95%置信区间，2,598至2,667]单位），在医疗保险支付政策变化前的接下来6个月中分别增加了3.4%和5.0%，而在支付政策变化后的6个月中分别增加了14.6%和14.8%。接受rHuEPO的透析患者每月rHuEPO的平均允许收费从政策变化前的455美元降至政策变化后立即降至349美元，因为当支付更多地依赖于每次治疗使用的rHuEPO量时，每单位rHuEPO的允许收费低于支付固定为每次治疗40美元时。由于剂量增加和新的可变支付，支付政策变化后第6个月rHuEPO的平均每月允许收费增至375美元。支付变化6个月后平均血细胞比容的未调整和调整变化均为正值，但临床上非常小（分别为0.3和0.2个百分点）。（摘要截取自400字）
