消除高心血管风险的低收入老年人的药费:随机对照试验
David J T Campbell1,2,3,4, Chad Mitchell5, Brenda R Hemmelgarn6
1Department of Community Health Sciences (D.J.T.C., M.T., P.F., J.Z., J.F., D.V.E., B.J.M.), Cumming School of Medicine, University of Calgary, Canada.
Circulation
|March 5, 2023
概括
消除低收入老年心脏病患者的药费并没有改善临床结果或降低医疗费用. 观察到适度改善药物坚持,但没有转化为更好的健康结果.
科学领域:
- 心血管医学
- 健康经济学
- 公共卫生政策
背景情况:
- 每8名心脏病患者中就有1人不服药,
- 低收入的老年人有较高的心血管风险,
- 共同支付成本是预防心血管疾病所需高价值药物的重要障碍.
研究的目的:
- 调查是否消除高价值药物的共同支付改善了高心血管风险的低收入老年人的临床结果.
- 评估共同支付消除对心血管事件,死亡率,生活质量和医疗保健成本的影响.
- 确定降低财政障碍对弱势患者药物坚持的影响.
主要方法:
- 一个随机的2x2因子试验,涉及加拿大阿尔伯塔省的4761名参与者.
- 干预组:免除15种高价值预防药物的共同支付 (通常的共同支付为30%).
- 主要结局:死亡,心肌梗塞,中风,冠状动脉复血管化和3年内心血管住院的综合结果;使用负二项回归分析.
主要成果:
- 消除共同支付并没有显著降低初级综合结果 (发生率比: 0. 84; P=0. 162).
- 在心肌梗塞,中风,心血管死亡或住院病例的发生率上没有显著差异.
- 在共同支付消除组 (P=0.016) 观察到对他类药物的适度增加,但在统计学上显著;然而,生活质量和整体医疗费用在各组之间没有显著差异.
结论:
- 消除低收入,高心血管风险的老年人的药费并没有改善临床结果或降低整体医疗费用.
- 虽然消除共支付导致药物坚持率略有增加,但这并没有转化为改善主要临床终点.
- 除了消除共同支付之外,还可能需要采取财政援助策略,以改善这一群体的心血管健康结果.
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