The impact of permissive and restrictive pharmaceutical policies on quetiapine dispensing: Evaluating a policy pendulum using interrupted time series analysis
The impact of permissive and restrictive pharmaceutical policies on quetiapine dispensing: Evaluating a policy pendulum using interrupted time series analysis
复制标题
DOI：
10.1002/pds.4408
复制
发表时间：
2018-04-01
影响因子：
2.6
通讯作者：
Pearson, Sallie-Anne
中科院分区：
文献类型：
--
作者：
Brett, Jonathan;Schaffer, Andrea;Pearson, Sallie-Anne
目的评估两项政策变化对澳大利亚奎硫平处方的影响：取消事先的处方授权(政策1：2007年7月)和取消25毫克奎硫平的重复处方(政策2：2014年1月)。方法我们使用药品福利计划索赔数据(2005年7月至2015年12月)进行了中断的时间序列分析。我们评估了这两项政策对奎硫平月度配药(25毫克和25毫克)的影响，以及政策变化2对每月25毫克停药和从25毫克转向其他奎硫平强度的影响。我们还估计了这两项政策对开始服用25毫克药物后潜在不适当治疗(没有剂量增加的证据)的人比例的影响。结果随着先前授权的取消，药物福利计划10%样本中的25毫克和25毫克奎硫平的处方分别增加了11个/月(95%可信区间：2-21)和14个/月(95%可信区间：8-20)。去除25毫克重复后，永久性地减少了1072次(95%可信区间773-1371)剂量，并增加了停用这种强度；48%的人停用了25毫克的剂量，完全停用了奎硫平；其余的人继续使用更高强度的奎硫平。我们观察到最小的转换到其他奎硫平的强度。在政策改变1之后，不适当的25 mg治疗没有改变，在政策改变2之后，不适当的25 mg治疗减少了(79%到76%，P=0.05)。结论需要更细微的政策来确保适当地获得25 mg奎硫平以进行剂量递增，同时不鼓励在风险和益处的证据不清楚的适应症中使用。
PurposeTo evaluate the impact of 2 policy changes on quetiapine dispensing in Australia: removal of prior authorisation for prescribing (policy 1: July 2007) and removal of repeat prescriptions for 25-mg quetiapine (policy 2: January 2014).MethodsWe performed an interrupted time series analysis using Pharmaceutical Benefits Scheme claims data (July 2005 to December 2015). We assessed the impact of both policies on monthly quetiapine dispensing (25mg and >25mg) and the impact of policy change 2 on monthly rates of 25-mg discontinuation and switching from 25mg to other quetiapine strengths. We also estimated the impact of both policies on the proportion of people with potentially inappropriate therapy (no evidence of dose escalation) following 25-mg initiation.ResultsFollowing removal of prior authorisation, 25-mg and >25-mg quetiapine dispensing in the Pharmaceutical Benefits Scheme 10% sample increased by 11/month (95% CI: 2-21) and 14/month (95% CI: 8-20), respectively. After removing 25-mg repeats, there was a permanent decrease of 1072 (95% CI 773-1371) dispensings and an increase in discontinuation of this strength; 48% of people dispensed the 25-mg strength that discontinued, discontinued quetiapine completely; the remainder continued to use higher quetiapine strengths. We observed minimal switching to other quetiapine strengths. There was no change in inappropriate 25-mg therapy following policy change 1 and a small decrease (79% to 76%, P=0.05) following policy change 2.ConclusionMore nuanced policies are needed to ensure the appropriate access to 25-mg quetiapine for dose escalation while discouraging use for indications where the evidence of risk and benefit is unclear.