薬局給付と慢性病者の薬物使用
Dana P Goldman1, Geoffrey F Joyce, Jose J Escarce
1RAND, Santa Monica, Calif 90407-2138, USA. dgoldman@rand.org
JAMA
|May 20, 2004
まとめ
処方薬の共同支払いの増加は,慢性疾患を含む多くの医薬品の使用を大幅に削減しました. この価格感受性は,特に糖尿病患者にとって,潜在的に有害な健康結果についての懸念を高めています.
科学分野:
- 健康経済学とは
- 医薬品政策について
- 臨床薬局は,臨床薬局である.
背景:
- 医療プランでは,薬剤費をコントロールするために,費用分担がますます利用されています.
- これらのコストシェアリングの変更が薬物使用に与える影響を理解することは極めて重要です.
研究 の 目的:
- コストシェアリングの増加が一般的な薬物クラスの利用にどのように影響するか評価する.
- 民間保険の個人および慢性疾患の患者を対象に,これらの効果を検証する.
主な方法:
- 関連薬局の主張と健康プランのデータ (1997-2000年) の遡及的分析.
- 民間保険の受益者52万8000人以上を対象とした.
- 薬物供給日における共同支払いの2倍化の影響を調査した.
主要な成果:
- コペイメントの倍増により,8つの治療クラス,特にNSAIDと抗ヒスタミン剤の使用量が減少しました.
- 抗高脂血症薬,抗潰瘍薬,抗喘息薬,抗高血圧薬,抗うつ薬,抗糖尿病薬の有意な減少が観察されました.
- 慢性疾患の患者の薬剤使用は反応が鈍かったが,関節炎患者のNSAIDおよび糖尿病患者の抗糖尿病薬の投与量が著しく減少した.
結論:
- 薬の使用,特にNSAIDや抗ヒスタミン剤などの間接的に使用される薬は,共同支払いの変化に敏感です.
- 使用減少は慢性疾患の薬剤ではより控えめであったが,有意な価格反応が観察された.
- 付加金の大幅な増加は,特に糖尿病患者の健康に悪影響を及ぼす可能性があります.
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