WITHDRAWING PAYMENT FOR NONSCIENTIFIC DRUG-THERAPY - INTENDED AND UNEXPECTED EFFECTS OF A LARGE-SCALE NATURAL EXPERIMENT
WITHDRAWING PAYMENT FOR NONSCIENTIFIC DRUG-THERAPY - INTENDED AND UNEXPECTED EFFECTS OF A LARGE-SCALE NATURAL EXPERIMENT
复制标题
DOI：
10.1001/jama.263.6.831
复制
发表时间：
1990-02-09
影响因子：
120.7
通讯作者：
AVORN, J
中科院分区：
文献类型：
--
作者：
SOUMERAI, SB;ROSSDEGNAN, D;AVORN, J
对无效医疗技术不予报销对临床决策的影响知之甚少。采用时间序列设计，我们研究了政府停止支付12类疗效可疑的药物（药物疗效研究实施药物）的影响，随机抽样的新泽西（美国）医疗补助人群（N = 390，465）和这些产品的定期用户的四个队列。我们测量了处方、支出和医生使用替代药物的总体水平的变化。虽然撤回的药物占基准年处方的75%，但在监管后，总体药物使用或支出没有明显减少;在整个42个月的研究中，处方率实际上从每个登记者每月0.86张处方上升到1.00张。控制既存趋势后，研究药物使用的估计下降（每1000名入组者每月21.7张处方）被替代药物使用的增加（33.7张处方）所抵消。观察到理想的和未改进的治疗替代。单独使用，削减对边际有效疗法的报销会导致理想和非预期的临床替代，并且可能不会降低成本。为了促进在治疗和经济上更适当的做法，可能需要用教育来补充这种限制。
Little is known about the effect on clinical decision making of nonreimbursement for ineffective medical technologies. Using a time-series design, we studied the effects of cessation of government payment for 12 categories of drugs of questionable efficacy (Drug Efficacy Study Implementation drugs) in a random sample of the New Jersey (USA) Medicaid population (N = 390, 465) and in four cohorts of regular users of these products. We measured changes in the overall levels of prescriptions, expenditures, and physicians'' use of substitute drugs. Although withdrawn drugs accounted for 75% of prescriptions in the base year, there was no measurable reduction in overall drug use or expenditures after the regulation; prescription rates actually rose from 0.86 to 1.00 monthly prescriptions per enrollee throughout the 42-month study. Controlling for preexisting trends, an estimated drop in the use of study drugs of 21.7 prescriptions per 1000 enrollees per month was offset by an increase in the use of substitute drugs of 33.7 prescriptions. Both desirable and unimproved therapeutic substitutions were observed. Used alone, curtailment of reimbursement for marginally effective therapies results in both desirable and unintended clinical substitutions and may not reduce costs. Supplementing such restrictions with education may be necessary to promote practices that are more therapeutically and economically appropriate.