转换为等效吸入装置的成本节约及其对健康结果的影响
2020/02/11
摘要
背景：将吸入器转换为更便宜的同类产品通常被认为是一种必要的节约成本的措施，然而这一措施对患者健康和医疗保健使用的影响不得而知。
方法：我们从2000年至2016年间英国初级保健电子医疗记录中确定了哮喘和慢性阻塞性肺疾病（COPD）的患者。采用自控病例系列来估计发病率（IRR）； 比较风险期间，暴露后3个月（由于财务转换）和控制期间（转换前和风险后期间）的结局率。 评估了四个结果：疾病加重，全科医生会诊，非特异性呼吸事件和药物不良事件。 计算药物占用比（MPR）以评估依从性。 使用2017年国家卫生局指示价格估算每当量剂量的成本差异
结果：我们确定了569 901例哮喘和171 231例慢性阻塞性肺病常规吸入器使用者，分别有2%和6%的人被调换吸入器。吸入器转换包括品牌到通用的的吸入器之间的切换，以及所有其他的切换(品牌到品牌，通用到通用，通用到品牌)，都与降低病情恶化相关(品牌到通用:IRR=0.75, 95% CI 0.64到0.88;其他:IRR=0.79, 95% CI 0.71～0.88)。性别、年龄、治疗级别、吸入器装置和吸入器技术检查未显著改变这种相关性(p<0.05)。会诊率、呼吸事件和药物不良事件无明显变化(会诊:IRR=1.00, 95% CI 0.99 - 1.01;呼吸事件:IRR=0.96, 95% CI 0.95～0.97;不良事件:IRR=1.05, 95% CI 0.96～1.15)。切换后依从性显著提高(中位MPR:切换前=54%，切换后=62%;p < 0.001)。如果将定期使用吸入器的患者换成同等价格的吸入器，每年可以节省大约600万英镑
结论：在哮喘或COPD患者中改用同等的吸入器似乎是安全的，并且不会对患者的健康或医疗保健利用产生负面影响。
Cost saving of switching to equivalent inhalers and its effect on health outcomes.
Bloom CI, Douglas I, Olney J, et al. Thorax. 2019 Aug 5.
Abstract
Background：Switching inhalers to cheaper equivalent products is often advocated as a necessary cost saving measure, yet the impact on patient’s health and healthcare utilisation has not been measured.
Methods：We identified asthma and chronic obstructive pulmonary disease (COPD) patients from UK primary care electronic healthcare records between 2000 and 2016. A self-controlled case series was used to estimate incidence rate ratios (IRR); comparing outcome rates during the risk period, 3 months after the exposure (financially motivated switch), and control periods (preswitch and postrisk period). Four outcomes were assessed: disease exacerbation, general practitioner consultation, non-specific respiratory events and adverse-medication events. Medication possession ratio (MPR) was calculated to assess adherence. 2017 National Health Service indicative prices were used to estimate cost differences per equivalent dose.
Results：We identified a cohort of 569 901 asthma and 171 231 COPD regular inhaler users, 2% and 6% had been switched, respectively. Inhaler switches between a brand-to-generic inhaler, and all other switches (brand-to-brand, generic-to-generic, generic-to-brand), were associated with reduced exacerbations (brand-to-generic: IRR=0.75, 95% CI 0.64 to 0.88; all other: IRR=0.79, 95% CI 0.71 to 0.88). Gender, age, therapeutic class, inhaler device and inhaler-technique checks did not significantly modify this association (p<0.05). The rate of consultations, respiratory-events and adverse-medication events did not change significantly (consultations: IRR=1.00, 95% CI 0.99 to 1.01; respiratory-events: IRR=0.96, 95% CI 0.95 to 0.97; adverse-medication-events: IRR=1.05, 95% CI 0.96 to 1.15). Adherence significantly increased post-switch (median MPR: pre-switch=54%, post-switch=62%; p<0.001). Switching patients, in the cohort of regular inhaler users, to the cheapest equivalent inhaler, could have saved around £6 million annually.
Conclusion：Switching to an equivalent inhaler in patients with asthma or COPD appeared safe and did not negatively affect patient’s health or healthcare utilisation.
背景：将吸入器转换为更便宜的同类产品通常被认为是一种必要的节约成本的措施，然而这一措施对患者健康和医疗保健使用的影响不得而知。
方法：我们从2000年至2016年间英国初级保健电子医疗记录中确定了哮喘和慢性阻塞性肺疾病（COPD）的患者。采用自控病例系列来估计发病率（IRR）； 比较风险期间，暴露后3个月（由于财务转换）和控制期间（转换前和风险后期间）的结局率。 评估了四个结果：疾病加重，全科医生会诊，非特异性呼吸事件和药物不良事件。 计算药物占用比（MPR）以评估依从性。 使用2017年国家卫生局指示价格估算每当量剂量的成本差异
结果：我们确定了569 901例哮喘和171 231例慢性阻塞性肺病常规吸入器使用者，分别有2%和6%的人被调换吸入器。吸入器转换包括品牌到通用的的吸入器之间的切换，以及所有其他的切换(品牌到品牌，通用到通用，通用到品牌)，都与降低病情恶化相关(品牌到通用:IRR=0.75, 95% CI 0.64到0.88;其他:IRR=0.79, 95% CI 0.71～0.88)。性别、年龄、治疗级别、吸入器装置和吸入器技术检查未显著改变这种相关性(p<0.05)。会诊率、呼吸事件和药物不良事件无明显变化(会诊:IRR=1.00, 95% CI 0.99 - 1.01;呼吸事件:IRR=0.96, 95% CI 0.95～0.97;不良事件:IRR=1.05, 95% CI 0.96～1.15)。切换后依从性显著提高(中位MPR:切换前=54%，切换后=62%;p < 0.001)。如果将定期使用吸入器的患者换成同等价格的吸入器，每年可以节省大约600万英镑
结论：在哮喘或COPD患者中改用同等的吸入器似乎是安全的，并且不会对患者的健康或医疗保健利用产生负面影响。
（ 中国医科大学附属第一医院 李文扬 摘译 杨冬 审校）
（Bloom CI, Douglas I, Olney J, et al. Thorax. 2019 Aug 5.）
Cost saving of switching to equivalent inhalers and its effect on health outcomes.
Bloom CI, Douglas I, Olney J, et al. Thorax. 2019 Aug 5.
Abstract
Background：Switching inhalers to cheaper equivalent products is often advocated as a necessary cost saving measure, yet the impact on patient’s health and healthcare utilisation has not been measured.
Methods：We identified asthma and chronic obstructive pulmonary disease (COPD) patients from UK primary care electronic healthcare records between 2000 and 2016. A self-controlled case series was used to estimate incidence rate ratios (IRR); comparing outcome rates during the risk period, 3 months after the exposure (financially motivated switch), and control periods (preswitch and postrisk period). Four outcomes were assessed: disease exacerbation, general practitioner consultation, non-specific respiratory events and adverse-medication events. Medication possession ratio (MPR) was calculated to assess adherence. 2017 National Health Service indicative prices were used to estimate cost differences per equivalent dose.
Results：We identified a cohort of 569 901 asthma and 171 231 COPD regular inhaler users, 2% and 6% had been switched, respectively. Inhaler switches between a brand-to-generic inhaler, and all other switches (brand-to-brand, generic-to-generic, generic-to-brand), were associated with reduced exacerbations (brand-to-generic: IRR=0.75, 95% CI 0.64 to 0.88; all other: IRR=0.79, 95% CI 0.71 to 0.88). Gender, age, therapeutic class, inhaler device and inhaler-technique checks did not significantly modify this association (p<0.05). The rate of consultations, respiratory-events and adverse-medication events did not change significantly (consultations: IRR=1.00, 95% CI 0.99 to 1.01; respiratory-events: IRR=0.96, 95% CI 0.95 to 0.97; adverse-medication-events: IRR=1.05, 95% CI 0.96 to 1.15). Adherence significantly increased post-switch (median MPR: pre-switch=54%, post-switch=62%; p<0.001). Switching patients, in the cohort of regular inhaler users, to the cheapest equivalent inhaler, could have saved around £6 million annually.
Conclusion：Switching to an equivalent inhaler in patients with asthma or COPD appeared safe and did not negatively affect patient’s health or healthcare utilisation.
上一篇：
2型哮喘单克隆抗体的系统评价及网络meta分析
下一篇：
哮喘和皮肤过敏的新生物治疗方法
