Pre-exposure prophylaxis for preventing acquisition of HIV: A cross-sectional study of patients, prescribers, uptake, and spending in the United States, 2015-2016
Pre-exposure prophylaxis for preventing acquisition of HIV: A cross-sectional study of patients, prescribers, uptake, and spending in the United States, 2015-2016
复制标题
DOI：
10.1371/journal.pmed.1003072
复制
发表时间：
2020-04-01
期刊：
影响因子：
15.8
通讯作者：
De Lew, Nancy
中科院分区：
文献类型：
--
作者：
Chan, Stephanie S.;Chappel, Andre R.;De Lew, Nancy
2015年，美国约有40，000例新的艾滋病毒诊断。暴露前预防（PrEP）是降低艾滋病毒感染风险的有效策略;然而，可以从中受益的人的吸收已经滞后。在这项研究中，我们1）将处方PrEP的患者的特征与新诊断为HIV感染的患者进行了比较，2）确定了处方PrEP的从业者的专业，3）确定了美国境内PrEP吸收相对较低的大都市统计区（MSA），和4）报告的中位数金额支付的患者和第三方支付者为PrEP.Methods和findingsWe分析处方药索赔的个人规定PrEP在综合数据诗句（IDV）Symphony Health的2015年9月至2016年8月期间的数据，以描述美国的PrEP患者、处方者、相对吸收和支付方式。数据可用于75，839名处方PrEP的个人，并将结果外推至约101，000人，这不到110万PrEP适用的成年人的10%。与新诊断的HIV感染者相比，PrEP患者更可能是非西班牙裔白色人（45%对26.2%），老年人（35-44岁为25%对19%），男性（94%对81%），而不是住在南方（30%对52%居住在南方）。使用MSA内PrEP患者数量与新诊断的HIV感染者数量的比率，我们发现PrEP摄入量相对较低的MSA集中在南部。在约24，000名处方PrEP的提供者中，三分之二的人报告初级保健是他们的专业。与疾病控制和预防中心（CDC）艾滋病毒监测特别报告中报告的2015年至2016年确诊艾滋病毒感染者（PLWH）用于支付抗逆转录病毒治疗的支付方式类型相比，PrEP患者更有可能使用商业健康保险（80%对35%），不太可能使用公共医疗保险或公共赞助的援助计划来支付PrEP（12%对45%的医疗补助）。第三方支付者支付了95%的PrEP费用。总体而言，我们估计每位患者每年在PrEP上的自付支出中位数约为72美元。这项研究的局限性包括数据库中未纳入患者处方索赔的信息缺失，对于那些纳入的患者，一些患者的诊断，种族/民族，教育程度和收入信息缺失（34%36%）。在美国，许多可以从PrEP中受益的人没有接受这种艾滋病毒预防药物，而那些处方PrEP的人与更广泛的有感染艾滋病毒风险的人群有着显著不同的特征分布。PrEP患者更有可能使用商业或私人保险支付PrEP，而PLWH更有可能使用公共赞助的项目支付抗逆转录病毒治疗。解决PrEP的可负担性问题，并以其他方式在有PrEP适应症的人群中推广其使用，是帮助结束艾滋病毒流行的重要机会。
BackgroundIn 2015, there were approximately 40,000 new HIV diagnoses in the United States. Pre-exposure prophylaxis (PrEP) is an effective strategy that reduces the risk of HIV acquisition; however, uptake among those who can benefit from it has lagged. In this study, we 1) compared the characteristics of patients who were prescribed PrEP with individuals newly diagnosed with HIV infection, 2) identified the specialties of practitioners prescribing PrEP, 3) identified metropolitan statistical areas (MSAs) within the US where there is relatively low uptake of PrEP, and 4) reported median amounts paid by patients and third-party payors for PrEP.Methods and findingsWe analyzed prescription drug claims for individuals prescribed PrEP in the Integrated Data verse (IDV) from Symphony Health for the period of September 2015 to August 2016 to describe PrEP patients, prescribers, relative uptake, and payment methods in the US. Data were available for 75,839 individuals prescribed PrEP, and findings were extrapolated to approximately 101,000 individuals, which is less than 10% of the 1.1 million adults for whom PrEP was indicated. Compared to individuals with newly diagnosed HIV infection, PrEP patients were more likely to be non-Hispanic white (45% versus 26.2%), older (25% versus 19% at ages 35-44), male (94% versus 81%), and not reside in the South (30% versus 52% reside in the South).Using a ratio of the number of PrEP patients within an MSA to the number of newly diagnosed individuals with HIV infection, we found MSAs with relatively low uptake of PrEP were concentrated in the South. Of the approximately 24,000 providers who prescribed PrEP, two-thirds reported primary care as their specialty. Compared to the types of payment methods that people living with diagnosed HIV (PLWH) used to pay for their anti-retroviral treatment in 2015 to 2016 reported in the Centers for Disease Control and Prevention (CDC) HIV Surveillance Special Report, PrEP patients were more likely to have used commercial health insurance (80% versus 35%) and less likely to have used public healthcare coverage or a publicly sponsored assistance program to pay for PrEP (12% versus 45% for Medicaid). Third-party payors covered 95% of the costs of PrEP. Overall, we estimated the median annual per patient out-of-pocket spending on PrEP was approximately US$72. Limitations of this study include missing information on prescription claims of patients not included in the database, and for those included, some patients were missing information on patient diagnosis, race/ethnicity, educational attainment, and income (34%36%).ConclusionsOur findings indicate that in 2015-2016, many individuals in the US who could benefit from being on PrEP were not receiving this HIV prevention medication, and those prescribed PrEP had a significantly different distribution of characteristics from the broader population that is at risk for acquiring HIV. PrEP patients were more likely to pay for PrEP using commercial or private insurance, whereas PLWH were more likely to pay for their antiretroviral treatment using publicly sponsored programs. Addressing the affordability of PrEP and otherwise promoting its use among those with indications for PrEP represents an important opportunity to help end the HIV epidemic.