付款人补充剂增加了阿皮克萨班的水平:患者如何反应以及潜在的影响
Steven Deitelzweig1, Emi Terasawa2, Nipun Atreja3
1Department of Hospital Medicine, Ochsner Clinic Foundation, New Orleans, LA, USA.
Current medical research and opinion
|July 31, 2023
概括
许多患者继续服用阿皮克萨班,尽管在补充剂水平增加后,自付费用更高. 然而,很大一部分人停止了口服抗凝剂 (OAC) 治疗,特别是那些具有较高并发症负担的人.
科学领域:
- 心脏病学 心脏病学
- 药物经济学 药物经济学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 阿皮克萨班是一种有效的口服抗凝剂 (OAC),用于预防心房动 (AF) 中的中风.
- 形式级别的增加可能会影响患者的获取和治疗坚持.
- 了解这些影响对于患者护理和医疗保健系统管理至关重要.
研究的目的:
- 评估阿皮克萨班配方剂量增加对医疗保险受益人转换处方药计划 (PDP) 的影响.
- 分析在阿皮克萨班等级升级后,口服抗凝剂 (OAC) 治疗模式的变化.
- 评估患者相关的自付 (OOP) 费用影响.
主要方法:
- 使用了全国性的Medicare索赔数据 (100%的样本) 获益者与A,B和D部分.
- 鉴定了用阿皮克萨班治疗心房动 (AF) 的患者,这些患者在2017年经历了配方药水平的增加.
- 描述了患者的OOP成本,PDP切换行为,以及随后的OAC治疗模式.
主要成果:
- 在1845名患者中,97.7%的患者面临阿皮克萨班水平从3增加到4.
- 大约4%的患者转换了PDP,其中大多数人继续使用较低级别的apixaban.
- 在那些继续使用同一PDP的人中,57.5%的人继续服用阿皮克萨班,尽管OOP成本较高 (54美元至135美元),而30.1%的人停止了OAC,显示出更高的并发症负担.
结论:
- 尽管成本增加,但大多数患者继续接受阿皮克萨班治疗,这表明治疗惯性.
- 很大一部分患者在增加阿皮克萨班水平后停止了OAC治疗.
- 较高的并发症负担与OAC停止相关,突出了脆弱的患者群体.
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