The Effect of Pharmaceutical Innovation on Longevity: Patient Level Evidence from the 1996–2002 Medical Expenditure Panel Survey and Linked Mortality Public-use Files
The Effect of Pharmaceutical Innovation on Longevity: Patient Level Evidence from the 1996–2002 Medical Expenditure Panel Survey and Linked Mortality Public-use Files
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药物创新对长寿的影响：来自 1996-2002 年医疗支出小组调查和相关死亡率公共使用文件的患者层面证据
DOI：
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发表时间：
2012
影响因子：
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通讯作者：
F. Lichtenberg
中科院分区：
文献类型：
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作者：
F. Lichtenberg
摘要：本研究采用患者水平的数据来分析制药技术变革对美国老年人寿命的影响。以前的患者水平研究不能控制重要的患者属性，如教育、收入和种族；他们没有提供使用新药对预期寿命影响的估计，也没有提供新药相对于旧药的总体成本效益；而且它们不是基于具有全国代表性的个人样本。我们的数据主要来自医疗支出小组调查和相关死亡率公共使用档案，使我们能够克服这些限制。我们调查了一个人使用的处方药的年份（美国食品和药物管理局批准的年份）对他或她的生存和医疗支出的影响，控制了一些人口统计学特征和指标以及健康状况的决定因素。当我们只控制年龄、性别和采访年份时，我们估计药物年份每增加1年，预期寿命增加0.52%。控制更广泛的其他属性（一个人开始服用药物的平均年份，以及活动限制、种族、教育、家庭收入占贫困线的百分比、保险覆盖范围、人口普查地区、体重指数、吸烟和100多种医疗条件等虚拟变量）实际上对药物使用年限对预期寿命的影响的估计没有影响。1996年至2003年间，处方药的平均年份增加了6.6年。据估计，这使美国老年人的预期寿命增加了0.41-0.47岁。这表明，1996-2003年期间，美国老年人预期寿命增加了0.6年，其中不少于三分之二是由于药物年份的增加。据估计，1996-2003年药品年份的增加也使每位美国老年人的年度药品支出增加了207美元，每位美国老年人的年度总医疗支出增加了218美元。这意味着药物创新的增量成本效益比（每生命年获得的成本）约为12,900美元。这种对使用新药所获得的每生命年成本的估计，只是领先经济学家对（愿意支付的）额外生命年价值的估计的一小部分。这也与临床试验的估计一致。
Abstract This study uses patient-level data to analyze the effect of technological change embodied in pharmaceuticals on the longevity of elderly Americans. Previous patient-level studies could not control for important patient attributes such as education, income, and race; they did not provide estimates of the effect of using newer drugs on life expectancy, or of the overall cost-effectiveness of new drugs relative to old drugs; and they were not based on nationally representative samples of individuals. Our data, primarily derived from the Medical Expenditure Panel Survey and the Linked Mortality Public-use Files, enable us to overcome those limitations. We investigate the effect of the vintage (year of U.S. Food and Drug Administration approval) of the prescription drugs used by an individual on his or her survival and medical expenditure, controlling for a number of demographic characteristics and indicators and determinants of health status. When we control only for age, sex, and interview year, we estimate that a 1-year increase in drug vintage increases life expectancy by 0.52%. Controlling for a much more extensive set of other attributes (the mean year the person started taking his or her medications, and dummy variables for activity limitations, race, education, family income as a percent of the poverty line, insurance coverage, Census region, body mass index, smoking, and more than 100 medical conditions) has virtually no effect on the estimate of the effect of drug vintage on life expectancy. Between 1996 and 2003, the mean vintage of prescription drugs increased by 6.6 years. This is estimated to have increased the life expectancy of elderly Americans by 0.41–0.47 years. This suggests that not less than two-thirds of the 0.6-year increase in the life expectancy of elderly Americans during 1996–2003 was due to the increase in drug vintage. The 1996–2003 increase in drug vintage is also estimated to have increased annual drug expenditure per elderly American by $207, and annual total medical expenditure per elderly American by $218. This implies that the incremental cost-effectiveness ratio (cost per life-year gained) of pharmaceutical innovation was about $12,900. This estimate of the cost per life-year gained from the use of newer drugs is a small fraction of leading economists’ estimates of the value of (willingness to pay for) an additional year of life. It is also consistent with estimates from clinical trials.
影响因子：
9.7
作者：
Meara, Ellen R.;Richards, Seth;Cutler, David M.
通讯作者：
Cutler, David M.