Remibursement Limits, Antidepressants, and Outcomes

描述（由申请人提供）：处方药的收入扣除额（IBDs）要求老年患者支付所有药物费用，最高金额由其收入决定；这种方法已被提议用于控制潜在的医疗保险药物福利计划的成本。服用抗抑郁药的老年患者可能特别容易受到ibd的不良影响，因为他们资源有限，经常需要多种药物，对不适当服用方案的易感性，以及与服用抗抑郁药相关的耻辱感。另一方面，抗抑郁药是许多卫生系统中支出最大的单一药物。ibd可能包含抗抑郁药的成本而没有不良影响，从而确保药物援助计划的财政可行性。2003年7月，不列颠哥伦比亚省65英镑或65英镑（约等于52万英镑）的居民将开始IBD计划，自费支付所有药费，最高可达其收入的2-4%。我们将使用综合的药物和卫生保健利用数据库以及来自访谈的以患者为中心的信息来评估在大量稳定的老年抗抑郁药使用者中这种实质性的覆盖变化。中断时间序列回归分析将确定ibd对自杀未遂、住院、急诊室护理、疗养院住宿、门诊就诊、抗抑郁药停药、次优方案的使用、总体净货币节省和抗抑郁药的自付费用的影响。停止或改为潜在的次优方案的老年人最有可能遭受ibd的不良后果，但即使是严重的影响也可能在总体分析中被遗漏。我们将重点关注停药或改变治疗方案的高危患者，以观察IBDs是否对健康、药物利用或经济结果产生负面影响。利用在访谈中获得的以患者为中心的信息，我们将确定老年人在应对更大的抗抑郁药物费用分摊时所使用的负担和应对策略，例如减少药物使用、获取非传统药物来源或不使用必需品。我们将研究在患者完全负责支付药费和完全报销药费的年度期间，抑郁症的严重程度和其他负担是否更大。我们将开展广泛的宣传活动，包括召开一次关于老年精神病药物使用者药物成本控制政策的国际讲习班。我们还将利用其他国家和国际论坛，为正在进行的关于易受伤害的老年抑郁症患者药物覆盖的辩论提供信息。

DESCRIPTION (provided by applicant): Income-based deductibles (IBDs) for prescription drugs require elderly patients to pay all drug costs up to an amount determined by their incomes; this approach has been proposed for containing costs in a potential Medicare drug benefit program. Older patients taking antidepressants may be especially vulnerable to adverse effects from IBDs because of their limited resources, frequent need for multiple drugs, susceptibility to inappropriately taken regimens, and stigma associated with taking antidepressants. On the other hand, antidepressants are the single largest drug expenditure in many health systems. It is possible that IBDs may contain antidepressant costs without adverse effects, ensuring the fiscal viability of drug assistance programs. In July 2003, British Columbia residents equal to or >65 (N equal to approximately 520,000) will begin an IBD program, paying all drug costs up to 2-4% of their income out-of-pocket. We will use comprehensive drug and health care utilization databases and patient-centered information from interviews to evaluate this substantial coverage change in a large, stable population of elderly antidepressant users. Interrupted time-series regression analyses will identify the impact of IBDs on completed suicides and attempts, hospitalizations, emergency room care, nursing home stays, outpatient visits, antidepressant discontinuation, use of suboptimal regimens, overall net monetary savings, and out-of-pocket expenses for antidepressants. Elderly who discontinue or change to potentially suboptimal regimens are most likely to suffer adverse outcomes from IBDs, yet even severe effects in them may be missed in overall analyses. We will focus on high-risk patients who discontinue or change regimens to see if IBDs negatively impact health, utilization, or economic outcomes. Using patient-centered information captured in interviews, we will identify the burdens and coping strategies elderly use to deal with greater antidepressant cost-sharing, such as reducing drug use, obtaining nontraditional sources of drugs, or doing without necessities. We will examine whether depression severity and other burdens are greater during annual periods when patients are fully responsible for paying vs. fully reimbursed for their drugs. We will conduct extensive dissemination activities, including convening an international workshop on drug cost containment policies among elderly users of psychiatric medications. We will also use other national and international forums to inform ongoing debates over drug coverage for vulnerable elderly patients with depression.