Cost-effectiveness of full medicare coverage of angiotensin-converting enzyme inhibitors for beneficiaries with diabetes
Cost-effectiveness of full medicare coverage of angiotensin-converting enzyme inhibitors for beneficiaries with diabetes
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DOI：
10.7326/0003-4819-143-2-200507190-00007
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发表时间：
2005-07-19
影响因子：
39.2
通讯作者：
Vijan, S
中科院分区：
文献类型：
--
作者：
Rosen, AB;Hamel, MB;Vijan, S
背景资料：血管紧张素转换酶（ACE）抑制剂可减缓糖尿病患者肾脏疾病进展，降低心脏病发病率和死亡率。患者的自付费用构成了使用这种有效疗法的障碍。目的：估计ACE抑制剂对糖尿病受益人的第一美元覆盖（无成本分摊）的医疗保险的成本效益。设计：马尔可夫模型，成本和收益折扣为3%.Data来源：已发表的文献和医疗保险索赔数据。目标人群：65岁的糖尿病医疗保险受益人。时间范围：终身。视角：医疗保险和社会干预：我们评估了ACE抑制剂的医疗保险第一美元覆盖率与当前实践的比较（无保险）和新的医疗保险药物福利。（2003年美元）、质量调整寿命年（QHMS）、寿命年和增量成本效益。与目前的做法相比，ACE抑制剂的第一美元保险既挽救了生命又节省了金钱（每个医疗保险受益人获得0.23个Qs和节省1606美元）。与新的医疗保险药物福利相比，第一美元覆盖仍然是一个占主导地位的战略（0.15 Qs获得，节省922美元）。敏感性分析结果：结果是最敏感的ACE抑制剂的使用增加，我们的估计，但是，如果ACE抑制剂的使用增加只有7.2%（从40%到47.2%），第一美元覆盖将仍然挽救生命，没有净成本的医疗保险。在从社会角度进行的分析中，效益相似，节省的成本更大。局限性：结果取决于基础数据和假设的准确性。更慷慨的药物覆盖对药物治疗adherence.Conclusions的影响：医疗保险的第一美元覆盖ACE抑制剂的受益人糖尿病患者似乎延长寿命，降低医疗保险计划的成本。减少计划成本可能会导致更多的钱花在老年人的其他医疗保健需求。
Background: Angiotensin-converting enzyme (ACE) inhibitors slow renal disease progression and reduce cardiac morbidity and mortality in patients with diabetes. Patients' out-of-pocket costs pose a barrier to using this effective therapy.Objective: To estimate the cost-effectiveness to Medicare of first-dollar coverage (no cost sharing) of ACE inhibitors for beneficiaries with diabetes.Design: Markov model with costs and benefits discounted at 3%.Data Sources: Published literature and Medicare claims data.Target Population: 65-year-old Medicare beneficiary with diabetes.Time Horizon: Lifetime. Perspective: Medicare and societal.Interventions: we evaluated Medicare first-dollar coverage of ACE inhibitors compared with current practice (no coverage) and the new Medicare drug benefit.Outcome Measures: Costs (2003 U.S. dollars), quality-adjusted life-years (QALYs), life-years, and incremental cost-effectiveness.Results of Base-Case Analysis: Compared with current practice, first-dollar coverage of ACE inhibitors saved both lives and money (0.23 QALYs gained and $1606 saved per Medicare beneficiary). Compared with the new Medicare drug benefit, first-dollar coverage remained a dominant strategy (0.15 QALYs gained, $922 saved).Results of Sensitivity Analysis: Results were most sensitive to our estimate of increase in ACE inhibitor use; however, if ACE inhibitor use increased by only 7.2% (from 40% to 47.2%), first-dollar coverage would remain life-saving at no net cost to Medicare. In analyses conducted from the societal perspective, benefits were similar and cost savings were larger.Limitations: Results depend on accuracy of the underlying data and assumptions. The effect of more generous drug coverage on medication adherence is uncertain.Conclusions: Medicare first-dollar coverage of ACE inhibitors for beneficiaries with diabetes appears to extend life and reduce Medicare program costs. A reduction in program costs may result in more money to spend on other health care needs of the elderly.