Remibursement Limits, Antidepressants, and Outcomes

报销限额、抗抑郁药和结果

基本信息

批准号：
7024438
负责人：
Sebastian G. Schneeweiss
金额：
$ 34.21万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
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

项目摘要

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.

说明（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，金额不超过其收入确定的金额；提出这种方法是为了控制潜在的医疗保险药物福利计划的成本。服用抗抑郁药的老年患者可能特别容易受到炎症性肠病的不良影响，因为他们的资源有限、经常需要多种药物、容易接受不适当的治疗方案，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 可能会包含抗抑郁药物的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，不列颠哥伦比亚省年满 65 岁（N 约等于 520,000）的居民将开始 IBD 计划，自费支付所有药品费用，最高可达收入的 2-4%。我们将使用全面的药物和医疗保健利用数据库以及来自采访的以患者为中心的信息来评估大量稳定的老年抗抑郁药使用者群体中覆盖率的重大变化。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、抗抑郁药物停用、次优治疗方案的使用、总体净货币节省和自付费用的影响抗抑郁药的费用。停止或改变可能不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或改变治疗方案的高风险患者，看看 IBD 是否会对健康、利用率或经济结果产生负面影响。利用在访谈中获取的以患者为中心的信息，我们将确定老年人用于处理更大的抗抑郁费用分摊的负担和应对策略，例如减少药物使用、获取非传统药物来源或不做必需品。我们将研究在患者完全负责支付药物费用与全额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。我们将开展广泛的宣传活动，包括在老年精神科药物使用者中召开一次关于药物成本控制政策的国际研讨会。我们还将利用其他国家和国际论坛为正在进行的关于弱势老年抑郁症患者药物覆盖范围的辩论提供信息。