胰岛素自付费用和使用差异的趋势,2008-2021年
Elise S Tremblay1, Stephanie Argetsinger, Fang Zhang
1Division of Endocrinology, Boston Children's Hospital, 333 Longwood Ave, 6th Floor, Boston, MA 02115.
The American journal of managed care
|August 19, 2025
概括
胰岛素自付费用上升,特别是那些高扣除医疗保险的人. 降低胰岛素成本的政策应专注于这些群体和低收入患者,以改善获得和负担能力.
科学领域:
- 卫生经济学 卫生经济学
- 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:
- 胰岛素对于糖尿病管理至关重要.
- 胰岛素成本上升给患者带来了巨大的经济负担.
- 了解成本和利用趋势对于政策制定至关重要.
研究的目的:
- 分析胰岛素自付 (OOP) 成本和利用的趋势.
- 为了确定胰岛素OOP成本和使用的差异.
- 从2008年到2021年,研究商业保险患者中的这些趋势.
主要方法:
- 国家保险数据库 (2008-2021) 的回顾性时间序列分析.
- 每年量化胰岛素OOP成本和30天相当的填充量.
- 按收入水平 (低贫困和高贫困邮政编码) 和健康计划类型 (具有储蓄选项的高扣除健康计划[HDHP/SO]和非HDHP/SO) 进行分层分析.
主要成果:
- 从2008年到2014年,调整后的年平均胰岛素OOP成本在两种计划类型中都增加了.
- 与非HDHP/SO成员相比,患有HDHP/SO的成员始终显示胰岛素使用量减少.
- 低收入成员的胰岛素填充量始终较少,这表明进入障碍.
结论:
- 针对具有储蓄选项 (HDHP/SO) 成员的高扣除健康计划,可能会提高胰岛素OOP成本降低政策的效率.
- 政策还应考虑低收入患者,以解决胰岛素获取和负担能力方面的差异.
相关概念视频
Issues And Trends In Healthcare Delivery System
5.8K
The issues and trends in healthcare delivery are constantly changing. The COVID-19 pandemic is one recent issue that wreaked havoc on healthcare systems, causing a shortage of healthcare workers, high demand for medicines and supplies, and increased medical expenditure due to a lack of insurance. Other issues include rising healthcare costs and care fragmentation.
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
5.8K
Insulin: Dosing Regimen and Adverse Effects
257
Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
257
Insulin Formulations: Types and Delivery
270
Insulin preparations are categorized by their duration of action into short-acting and long-acting types. Two strategies are used to modify insulin's absorption and pharmacokinetic profile: slowing the absorption post-subcutaneous injection, or altering human insulin's amino acid sequence or protein structure. These changes retain the insulin's ability to bind to the insulin receptor, but alter its behavior in solution or after injection.
Short-acting insulins are divided into...
Short-acting insulins are divided into...
270
Insulin: The Receptor and Signaling Pathways
1.5K
Insulin action is mediated through a receptor tyrosine kinase, akin to the IGF-1 receptor. The number of receptors per cell varies significantly, from 40 on erythrocytes to 300,000 on adipocytes and hepatocytes. The insulin receptor consists of linked α/β subunit dimers, forming a heterotetramer glycoprotein with two extracellular α subunits and two β subunits spanning the membrane. The α subunits inhibit the inherent tyrosine kinase activity of the β subunits, but...
1.5K
Diabetes: Management and Pharmacotherapy
362
The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
362
Oral Hypoglycemic Agents: Biguanides and Glitazones
291
Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood...
291


