医疗补助扩展和限制政策对型肝炎的治疗
Nathan W Furukawa1, Susan Z Ingber1, Hasan Symum1
1Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
JAMA network open
|July 16, 2024
概括
医疗补助机构对用于治疗C型肝炎的直接作用抗病毒药物 (DAA) 的限制,包括纤维化和清醒要求,与接受护理的患者数量减少有关. 缓解这些DAA限制可能会改善C型肝炎治疗的准入.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 公共卫生政策 公共卫生政策
- 卫生经济学 卫生经济学
背景情况:
- 型肝炎是可用直接作用抗病毒药物 (DAA) 治愈的.
- 医疗补助计划对DAA访问实施了限制 (纤维化,清醒,处方者) 以管理成本.
- 了解这些限制的影响对于制定政策来提高治疗率至关重要.
研究的目的:
- 分析州级DAA限制和医疗补助扩张与医疗补助受益人中的DAA处方率之间的关联.
- 量化纤维化,清醒和处方限制对医疗补助人口中C型肝炎治疗吸收的影响.
主要方法:
- 采用2014-2021年医疗补助申请数据的横截面研究,涵盖所有50个州和华盛顿特区.
- 根据医疗补助扩展状态和特定的DAA限制类别,每10万名医疗补助接收者相比的DAA处方填充量.
- 采用多层Poisson回归来估计政策变量与治疗率之间的关联.
主要成果:
- 没有扩大医疗补助的司法管辖区显示,DAA治疗率明显较低 (ARR,0.56).
- 纤维化限制 (F3-F4:ARR,0.39; F1-F2:ARR,0.62) 和清醒要求 (6-12个月:ARR,0.65) 与治疗减少有关.
- 专家咨询限制显示了治疗的轻微增加 (ARR,1.05),而其他处方限制没有显著的影响.
结论:
- 医疗补助未扩展和限制性DAA政策 (纤维化,清醒) 与较低的C型肝炎治疗率有关.
- 减少或取消这些DAA限制的政策变化可能会显著增加医疗补助受益者治疗型肝炎的数量.
- 促进DAA的获取对于在医疗补助人口中实现型肝炎消除目标至关重要.
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