Remibursement Limits, Antidepressants, and Outcomes

描述（由申请人提供）：处方药的基于收入的免赔额（IBD）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医疗保险药物福利计划中的费用。服用抗抑郁药的老年患者可能特别容易受到IBD的不良反应的影响，因为他们的资源有限，经常需要多种药物，对不适当服用的方案敏感，以及与服用抗抑郁药相关的耻辱。另一方面，抗抑郁药是许多卫生系统中最大的单一药物支出。IBD可能包含抗抑郁药成本而不会产生不良影响，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岁或65岁以上的居民（N约等于520，000）将开始IBD计划，自费支付所有药物费用，最高可达其收入的2-4%。我们将使用全面的药物和医疗保健利用数据库和以患者为中心的信息，从访谈中评估这一重大覆盖面的变化，在一个大的，稳定的老年抗抑郁药使用者的人口。 中断的时间序列回归分析将确定IBD对自杀和自杀未遂、住院、急诊室护理、疗养院住宿、门诊就诊、抗抑郁药停药、使用次优方案、总体净货币储蓄和抗抑郁药自付费用的影响。 停止或改变为潜在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遗漏。我们将重点关注停止或改变治疗方案的高风险患者，以了解IBD是否会对健康，利用或经济结果产生负面影响。 使用以患者为中心的信息，在采访中，我们将确定老年人使用的负担和应对策略，以处理更大的抗抑郁药的成本分担，如减少药物使用，获得非传统的药物来源，或没有必需品。我们将研究抑郁症的严重程度和其他负担是否在患者完全负责支付与完全报销药物的年度期间更大。 我们将开展广泛的宣传活动，包括在使用精神药物的老年人中举办一次关于控制药物费用政策的国际讲习班。我们还将利用其他国家和国际论坛，为正在进行的关于弱势老年抑郁症患者药物覆盖范围的辩论提供信息。

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.