The Impact of Reducing Cardiovascular Medication Copayments on Health Spending and Resource Utilization
The Impact of Reducing Cardiovascular Medication Copayments on Health Spending and Resource Utilization
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DOI：
10.1016/j.jacc.2012.06.050
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发表时间：
2012-10-30
影响因子：
24
通讯作者：
Shrank, William H.
中科院分区：
文献类型：
--
作者：
Choudhry, Niteesh K.;Fischer, Michael A.;Shrank, William H.
目的本研究的目的是评估减少他汀类药物和氯吡格雷的共同支付对心血管资源利用、主要冠状动脉事件和保险公司支出的影响。背景共同支付被广泛用于控制健康支出，但会导致患者减少使用基本的心血管药物。减少心肌梗死后的二级预防的共同负担具有有益的影响，但这种策略对低风险患者和其他药物的影响仍不清楚。方法进行了评估的卫生保健支出和资源使用的一个大的自我保险的雇主，减少他汀类药物的共同负担的糖尿病或血管疾病患者，并减少氯吡格雷的共同负担的所有患者规定这种drug. Methods。将干预公司中符合条件的个人（n = 3，513）与来自其他没有此类政策的公司的对照组（n = 49，803）进行比较。采用分段回归模型和广义估计方程进行分析。结果降低自付费用与医生就诊率显著降低相关（相对变化：他汀类药物使用者：0.80; 95%置信区间[CI]：0.57 - 0.98;氯吡格雷使用者：0.87; 95% CI：0.59至0.96）以及住院和急诊入院（相对变化：他汀类药物使用者：0.90; 95% CI：0.80 - 0.92;氯吡格雷使用者：0.89; 95% CI：0.74 - 0.90），但不是主要冠状动脉事件。患者用于药物和其他医疗服务的自付支出减少（相对变化：他汀类药物使用者0.79; 95% CI：0.75 - 0.83;氯吡格雷使用者0.74; 95% CI：0.66 - 0.82）。提供更慷慨的覆盖范围并没有增加总支出（相对变化：他汀类药物使用者1.03; 95%CI：0.97至1.09;氯吡格雷使用者0.94; 95%CI：0.87至1.03）。结论降低他汀类药物和氯吡格雷的共同支付与医疗保健资源使用和患者自付费用的减少有关。该政策似乎对总体卫生支出没有影响。（J Am科尔心脏病学杂志2012;60：1817-24）（C）美国心脏病学会基金会2012年
Objectives The aim of this study was to evaluate the impact of reductions in statin and clopidogrel copayments on cardiovascular resource utilization, major coronary events, and insurer spending.Background Copayments are widely used to contain health spending but cause patients to reduce their use of essential cardiovascular medications. Reducing copayments for post-myocardial infarction secondary prevention has beneficial effects, but the impact of this strategy for lower risk patients and other drugs remains unclear.Methods An evaluation was conducted of health care spending and resource use by a large self-insured employer that reduced statin copayments for patients with diabetes or vascular disease and reduced clopidogrel copayments for all patients prescribed this drug. Eligible individuals in the intervention company (n = 3,513) were compared with a control group from other companies without such a policy (n = 49,803). Analyses were performed using segmented regression models with generalized estimating equations.Results Lowering copayments was associated with significant reductions in rates of physician visits (relative change: statin users 0.80; 95% confidence interval [CI]: 0.57 to 0.98; clopidogrel users: 0.87; 95% CI: 0.59 to 0.96) and hospitalizations and emergency department admissions (relative change: statin users 0.90; 95% CI: 0.80 to 0.92; clopidogrel users: 0.89; 95% CI: 0.74 to 0.90) although not major coronary events. Patient out-of-pocket spending for drugs and other medical services decreased (relative change: statin users 0.79; 95% CI: 0.75 to 0.83; clopidogrel users 0.74; 95% CI: 0.66 to 0.82). Providing more generous coverage did not increase overall spending (relative change: statin users 1.03; 95% CI: 0.97 to 1.09; clopidogrel users 0.94; 95% CI: 0.87 to 1.03).Conclusions Lowering copayments for statins and clopidogrel was associated with reductions in health care resource use and patient out-of-pocket spending. The policy appeared cost neutral with respect to overall health spending. (J Am Coll Cardiol 2012;60:1817-24) (C) 2012 by the American College of Cardiology Foundation