Impact of the Medicare Part D Benzodiazepine Exclusion on Managed Care Patients

医疗保险 D 部分苯二氮卓类药物排除对管理式护理患者的影响

• 批准号: 7315462
• 负责人: SUSAN Louise ETTNER
• 金额: $ 24.68万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-06-01 至 2009-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7315462
• 关键词: Accident and Emergency department; Affect; Anti-Anxiety Agents; Antidepressive Agents; Anxiety; Anxiety Disorders; Behavioral; Benzodiazepines; Caring; Clinical; Collaborations; Condition; Costs and Benefits; Data; Diagnosis; Drug Insurance; Drug Prescriptions; Elderly; Enrollment; Exclusion; Expenditure; Formularies; Guidelines; Health; Health Expenditures; Health Policy; Healthcare; Hip Fractures; Hospitalization; Insurance; Lead; Length of Stay; Link; Longitudinal Studies; Managed Care; Medicaid; Medical; Medicare; Mental Depression; Mental Health; Mental disorders; Modernization; Numbers; Outcome; Outpatients; Patient Care; Patients; Pattern; Pharmaceutical Preparations; Pharmacologic Substance; Physicians; Process; Psychotropic Drugs; Public Health; Pulmonary Emphysema; Recording of previous events; Research; Research Design; Research Personnel; Research Priority; Risk; Savings; Statutes and Laws; Subgroup; Tail; Testing; Time; Urinary Incontinence; Visit; base; behavioral health; beneficiary; comparison group; cost; falls; health economics; improved; older patient; programs; research study; response; trend

DESCRIPTION (provided by applicant): The new Medicare Part D program created by the Medicare Modernization Act categorically excludes benzodiazepines (BZDs), a mainstay of treatment for anxiety disorders, except for those patients with supplemental or Medicaid insurance. This exclusion, in effect since January 2006, is based on studies showing that BZD use in the elderly increases the risk of falls and hip fractures, and worsens conditions such as emphysema, urinary incontinence, and depression. This exclusion will likely improve health outcomes for elderly Medicare beneficiaries who are using BZDs inappropriately or have health conditions that are worsened by BZD use. However, it may worsen health outcomes for patients being treated appropriately with BZDs for anxiety disorders, especially if they are withdrawn abruptly from the medication or switched to less appropriate or efficacious psychotropic drugs. We examine the implications of the loss of BZD coverage resulting from the Medicare Part D exclusion using linked prescription drug, behavioral and medical claims for UnitedHealth Group Medicare Advantage plan beneficiaries enrolled since 2004. To assess short-term effects, we examine enrollees who had been using BZDs, both appropriately and inappropriately, before Medicare Part D began. To explore the long- term implications for cost and quality, we analyze treatment patterns among patients with anxiety diagnoses. Our specific aims are to examine the association between Medicare Part D implementation and 1) use and cost of psychotropic drugs other than benzodiazepines, and behavioral outpatient visits; and 2) hospital stays, emergency department visits, medical outpatient visits and total costs (also broken down by type). Our research uses pre-post and quasi-experimental study designs, using patient groups whose BZD coverage is unaffected by the Medicare Part D exclusion to control for secular time trends. Our research contributes to public health by looking at how one of the biggest health policy initiatives in recent history affects treatment of anxiety disorders, which are among the most prevalent and costly mental illnesses, and whether the loss of BZD coverage resulting from the Medicare Part D exclusion will lead to health care savings or costs. Our findings will inform the ongoing debate over amending Part D legislation to include BZD coverage by providing objective data to guide policymakers on the likely costs and benefits.

描述（由申请人提供）：《医疗保险现代化法案》创建的新医疗保险 D 部分计划明确排除苯二氮卓类药物 (BZD)，这是治疗焦虑症的主要药物，但拥有补充保险或医疗补助保险的患者除外。这项排除自 2006 年 1 月起生效，其依据是研究表明，老年人使用 BZD 会增加跌倒和髋部骨折的风险，并使肺气肿、尿失禁和抑郁等病症恶化。这项排除可能会改善那些不恰当地使用 BZD 或因使用 BZD 而导致健康状况恶化的老年医疗保险受益人的健康状况。然而，对于正在接受 BZD 治疗焦虑症的患者来说，其健康结果可能会恶化，特别是如果他们突然停药或改用不太合适或有效的精神药物。我们使用关联的处方药、行为和医疗索赔，研究了 Medicare D 部分排除导致的 BZD 承保损失对 2004 年以来加入的 UnitedHealth Group Medicare Advantage 计划受益人的影响。在 Medicare D 部分开始之前适当或不适当地使用 BZD。为了探讨对成本和质量的长期影响，我们分析了焦虑诊断患者的治疗模式。我们的具体目标是检查 Medicare D 部分的实施与 1) 除苯二氮卓类药物以外的精神药物的使用和费用以及行为门诊就诊之间的关联； 2) 住院时间、急诊科就诊、门诊就诊和总费用（也按类型细分）。我们的研究采用事前和准实验研究设计，使用 BZD 承保范围不受 Medicare D 部分排除影响的患者群体来控制长期时间趋势。我们的研究通过研究近代历史上最大的卫生政策举措之一如何影响焦虑症的治疗（焦虑症是最普遍和最昂贵的精神疾病之一），以及医疗保险 D 部分导致的 BZD 承保损失是否会为公众健康做出贡献。排除将导致医疗保健节省或费用。我们的研究结果将为正在进行的有关修改 D 部分立法以将 BZD 覆盖范围纳入其中的辩论提供信息，通过提供客观数据来指导政策制定者了解可能的成本和收益。