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成本，最高金额由他们的收入决定；这种方法已被提议用于在潜在的联邦医疗保险药物福利计划中控制成本。服用抗抑郁药物的老年患者可能特别容易受到IBDS不良反应的影响，因为他们的资源有限，经常需要多种药物，对不适当的服用方案敏感，以及与服用抗抑郁药物相关的耻辱。另一方面，在许多卫生系统中，抗抑郁药是最大的单一药物支出。IBD有可能包含抗抑郁药费用，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，不列颠哥伦比亚省相当于65岁或65岁(N相当于约520,000人)的居民将开始一项IBD计划，自掏腰包支付最高达收入的2%-4%的所有药费。我们将使用全面的药物和医疗保健利用数据库和采访中以患者为中心的信息来评估这一在大量稳定的老年抗抑郁药物使用人群中的实质性覆盖变化。中断的时间序列回归分析将确定IBD对已完成的自杀和企图、住院、急诊室护理、疗养院住宿、门诊就诊、抗抑郁药停用、使用次优方案、总体净节省金钱和自付抗抑郁药费用的影响。停止或改用可能不太理想的治疗方案的老年人最有可能遭受IBD的不良后果，但在总体分析中，即使是严重的影响也可能被遗漏。我们将重点关注停止治疗或改变治疗方案的高危患者，以了解IBD是否会对健康、利用率或经济结果产生负面影响。利用采访中收集的以患者为中心的信息，我们将确定老年人在更大程度上分担抗抑郁药成本时使用的负担和应对策略，例如减少药物使用、获得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物与完全报销药物的年度期间，抑郁症的严重程度和其他负担是否更大。我们将进行广泛的宣传活动，包括在老年精神科药物使用者中举办一次关于控制药品成本政策的国际研讨会。我们还将利用其他国家和国际论坛，为正在进行的关于脆弱的老年抑郁症患者的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.