McCombs J S, Nichol M B
Department of Pharmaceutical Economics and Policy, School of Pharmacy, University of Southern California, Los Angeles 90033.
Ann Pharmacother. 1993 Feb;27(2):155-61. doi: 10.1177/106002809302700203.
To evaluate whether a pharmacy-enforced treatment protocol successfully limited the use of a high-cost medication to high-risk patients.
A case study cost-effectiveness analysis was conducted to evaluate a treatment protocol for cefaclor. Episodes of care were defined, healthcare expenditures for all services were aggregated, and demographic data were retrieved from a five percent random sample of California Medicaid (Medi-Cal) recipients. Data were available for episodes occurring before cefaclor was made available under Medi-Cal.
Medi-Cal added cefaclor to its formulary, limiting its use to patients over 50 years of age with lower respiratory tract infections (LRTIs). The unit of analysis was an episode of outpatient antibiotic treatment.
Confirmed LRTI episodes and unconfirmed LRTI cefaclor episodes were analyzed, including multiple episodes of treatment for individual patients. A total of 7855 non-cefaclor LRTI episodes and 2556 cefaclor episodes were analyzed.
The primary outcome measures were healthcare expenditures three months after the initiation of antibiotic therapy, differentiated by type of service.
Physicians directed cefaclor toward higher-risk patients over age 50 years, even in unconfirmed LRTI episodes. Cefaclor use was estimated to reduce posttreatment costs by $388 per patient (p < 0.001), primarily because of reduced hospital expenditures of $366 (p < 0.001).
Pharmacy-enforced outpatient drug treatment protocols may be a viable alternative to restrictive formularies and prior authorization. In the case of cefaclor, the Medi-Cal treatment protocol appeared to allow high-risk patients better access to a high-cost medication while reducing total posttreatment costs.
评估药房强制执行的治疗方案是否成功地将一种高成本药物的使用限制于高危患者。
进行了一项案例研究成本效益分析，以评估头孢克洛的治疗方案。确定了护理事件，汇总了所有服务的医疗保健支出，并从加利福尼亚医疗补助（Medi-Cal）接受者的5%随机样本中检索了人口统计学数据。可获得在Medi-Cal提供头孢克洛之前发生的事件的数据。
Medi-Cal将头孢克洛添加到其药品目录中，将其使用限制于50岁以上患有下呼吸道感染（LRTI）的患者。分析单位是门诊抗生素治疗事件。
分析了确诊的LRTI事件和未确诊的LRTI头孢克洛事件，包括个体患者的多次治疗事件。共分析了7855例非头孢克洛LRTI事件和2556例头孢克洛事件。
主要结局指标是抗生素治疗开始后三个月的医疗保健支出，按服务类型区分。
即使在未确诊的LRTI事件中，医生也将头孢克洛用于50岁以上的高危患者。据估计，使用头孢克洛可使每位患者的治疗后成本降低388美元（p<0.001），主要是因为医院支出减少了366美元（p<0.001）。
药房强制执行的门诊药物治疗方案可能是限制性药品目录和预先授权的可行替代方案。就头孢克洛而言，Medi-Cal治疗方案似乎使高危患者能够更好地获得高成本药物，同时降低了治疗后的总成本。
