Utilization, price, and spending trends for antidepressants in the US Medicaid program
Utilization, price, and spending trends for antidepressants in the US Medicaid program
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DOI：
10.1016/j.sapharm.2007.06.019
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发表时间：
2008-09-01
影响因子：
3.9
通讯作者：
Patel, Nick C.
中科院分区：
文献类型：
--
作者：
Chen, Yan;Kelton, Christina M. L.;Patel, Nick C.
背景：抗抑郁药通常用于治疗重度抑郁症和其他精神疾病，并且是美国医疗补助计划中处方最广泛且最昂贵的药物类别之一。然而，该市场内的抗抑郁药物的使用和价格模式尚未得到充分表征。 目的：本研究旨在分析抗抑郁药物的使用和价格趋势，并量化医疗补助的市场份额竞争。方法：从医疗保险和医疗补助服务中心提供的国家医疗补助药房索赔文件中检索季度使用和支付数据。每个处方的季度价格是通过付款金额除以处方数量来估算的。我们进行了描述性时间序列分析，以评估 1991 年 1 月至 2005 年 12 月期间 3 个主要抗抑郁药亚类（选择性血清素再摄取抑制剂 (SSRI)、三环类抗抑郁药和其他抗抑郁药）以及这些亚类中的单个药物的使用情况、支出、市场份额和价格趋势。使用指数平滑模型，得出了 3 年市场份额预测。结果：从 1991 年到 2005 年，抗抑郁药处方总数从 682 万张增加到 3272 万张，增长了 380%。抗抑郁药物的总支出从 1991 年的 1.59 亿先令增至 2004 年的 22.6 亿美元，随后随着价格较低的氟西汀仿制药和 2003 年帕罗西汀仿制药的上市，2005 年又下降至 19.9 亿美元。SSRI 的支付市场份额从 1991 年的 40% 增加到 2005 年的 82%。 1997 年下降到 2005 年的 64%。预计 2008 年第四季度将达到 64%（95% 置信区间 [CI]：51-77%）。结论：抗抑郁药物支出的增加主要是由于使用率的增加；然而，许多研究的抗抑郁药的每张处方的平均价格也有所增加。改用仿制药可能会带来巨大的成本节约潜力。 (C) 2008 Elsevier Inc. 保留所有权利。
Background: Antidepressants are often used in the treatment of major depressive disorder and other mental illnesses, and constitute one of the most widely prescribed and costly medication classes in the US Medicaid Program. However, antidepressant utilization and price patterns within this market have not yet been adequately characterized.Objectives: This study was undertaken to analyze antidepressant drug utilization and price trends and to quantify market-share competition in Medicaid.Methods: Quarterly utilization and payment data were retrieved from the national Medicaid pharmacy claims files provided by the Centers for Medicare & Medicaid Services. Quarterly per-prescription prices were estimated by dividing the payment amounts by the number of prescriptions. Descriptive time series analysis was conducted to assess the trends of utilization, expenditures, market shares, and prices from January 1991 through December 2005, for 3 major antidepressant subclasses-Selective Serotonin Reuptake Inhibitors (SSRIs), Tricyclic Antidepressants, and Other Antidepressants-as well as for individual agents within these subclasses. Using exponential smoothing models, 3-year market-share forecasts were produced.Results: From 1991 to 2005, the total number of antidepressant prescriptions rose 380% from 6.82 million to 32.72 million. Total expenditures on antidepressants increased from S 159 million in 1991 to $2.26 billion in 2004, then decreased to $1.99 billion in 2005, following the entry of lower-priced generic fluoxetine in 2001 and generic paroxetine in 2003. The payment market share for the SSRIs increased from 40% in 1991 to 82% in 1997, then decreased to 64% in 2005. It is projected to be 64% (95% confidence interval [CI]: 51-77%) in 2008 quarter 4.Conclusions: Increases in antidepressant drug expenditures were primarily because of rising utilization; however, there was also some increase in average price per prescription for many of the antidepressants studied. Switching to generic drugs may offer significant cost-saving potential. (C) 2008 Elsevier Inc. All rights reserved.