Remibursement Limits, Antidepressants, and Outcomes

报销限额、抗抑郁药和结果

• 批准号: 6850814
• 负责人: Philip S Wang
• 金额: $ 35.8万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-03-01 至 2008-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6850814
• 关键词: Medicare /Medicaid; antidepressants; behavioral /social science research tag; clinical research; coping; emergency care; health behavior; health care cost /financing; health care service utilization; health economics; hospital utilization; human data; human old age (65+); human subject; income; managed care; mental disorder chemotherapy; meta analysis; nursing homes; outcomes research; outpatient care; statistics /biometry; suicide; therapy compliance; Medicare /Medicaid; antidepressants; behavioral /social science research tag; clinical research; coping; emergency care; health behavior; health care cost /financing; health care service utilization; health economics; hospital utilization; human data; human old age (65+); human subject; income; managed care; mental disorder chemotherapy; meta analysis; nursing homes; outcomes research; outpatient care; statistics /biometry; suicide; therapy compliance

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.

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，最高收入为其收入确定的金额；已经提出了这种方法，用于在潜在的Medicare药物福利计划中包含成本。服用抗抑郁药的老年患者可能特别容易受到IBD的不利影响，因为他们的资源有限，对多种药物的需求经常需要，易于服用治疗方案的易感性以及与服用抗抑郁药有关的污名。另一方面，抗抑郁药是许多卫生系统中最大的药物支出。 IBD可能在没有不利影响的情况下包含抗抑郁成本，从而确保药品援助计划的财政生存能力。 2003年7月，不列颠哥伦比亚省的居民等于或> 65（n等于520,000）将开始IBD计划，向所有药物成本支付高达其自付收入的2-4％。我们将使用综合的药物和医疗保健利用数据库和以患者为中心的访谈信息来评估大量，稳定的老年抗抑郁用户的覆盖范围变化。 中断的时间序列回归分析将确定IBD对完整的自杀，住院，急诊室护理，疗养院的影响，住宿，门诊就诊，抗抑郁药，使用次优先方案，整体净货币储蓄以及对抗议者的货运费用。 停止或改变潜在的次优方案的老年人最有可能遭受IBD的不利结果，但在整体分析中，即使是严重的影响也可能会遗漏。我们将专注于停止或改变方案的高风险患者，以查看IBD是否对健康，利用或经济成果产生负面影响。 使用访谈中捕获的以患者为中心的信息，我们将确定老年人使用的负担和应对策略来处理更大的抗抑郁药成本分担，例如减少药物使用，获得非传统药物来源或无需进行。我们将检查抑郁症的严重程度和其他负担在患者完全负责支付与完全偿还药物的情况下是否更大。 我们将开展广泛的传播活动，包括召集有关精神病药物老年使用者的药物成本遏制政策的国际研讨会。我们还将使用其他国家和国际论坛来告知有关弱势抑郁症患者的毒品覆盖的持续辩论。