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保险使用新型糖尿病药物的差异:全国代表性队列研究
Lurit Bepo1,2,3, Oanh K Nguyen4,5,6, Anil N Makam4,5,6
1Division of Hospital Medicine, San Francisco General Hospital, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA. lurit.bepo@ucsf.edu.
Journal of general internal medicine
|July 31, 2024
概括
新型糖尿病药物使用的种族差异在私人保险中最大. 医疗补助受益者之间没有差异,尽管他们的整体处方率最低,这表明保险覆盖影响了获得医疗补助的机会.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 药物经济学 药物经济学
- 糖尿病管理 糖尿病管理
背景情况:
- 少数群体面临更高的2型糖尿病 (T2DM) 患病率,但SGLT2抑制剂 (SGLT2i) 和GLP-1受体激动剂 (GLP1ra) 的使用较低.
- 这些新型药物显著降低了T2DM相关的发病率和死亡率.
- 机会差异可能源于各种保险覆盖,包括成本共享和事先授权.
研究的目的:
- 调查SGLT2i和GLP1ra利用的种族和民族差异是否因保险支付人而异.
- 确定保险类型在加剧或减轻T2DM患者药物获取差异中的作用.
主要方法:
- 使用2018-2019医疗支出小组调查数据进行横截面分析.
- 包括被诊断为糖尿病的成年患者 (≥18岁),其保险状况定义为≥7个月的保险 (私人,医疗保险或医疗补助).
- 种族/种族分类为白人 (非西班牙裔) 与非白人 (包括西班牙裔);主要结局是使用≥1 SGLT2i或GLP1ra.
主要成果:
- 分析包括4997名成年人 (代表每年2480万美国成年人患有糖尿病).
- 在私人保险 (16.1%对8.3%) 和医疗保险 (14.7%对11.0%) 群体中观察到有利于白人人的显著差异.
- 在医疗补助受益者 (10.0%与9.0%) 之间没有发现药物使用的显著种族/民族差异,尽管总体比率最低.
结论:
- 新型T2DM药物使用的种族/民族差异在拥有私人保险的人群中最为明显.
- 保险覆盖的类型显著影响观察到的差异,没有差异,但在医疗补助中使用率低.
- 对表单限制和自付费用的进一步研究至关重要,以解决SGLT2i和GLP1ra.的访问不平等问题.
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