臺灣降血壓藥物耗用型態及其經濟分析   全文下載

An Economic Evaluation on the Pharmaceutical Expenditure of Antihypertensive Agents in Taiwan from 1997 to 2002

本研究以全民健保1997~2002六年的門診申報檔案為範圍，分析不同類別降血壓藥物的耗用趨勢以及價量參數的變異。藥費變異的分析係以下列五項參數予以解釋：相對藥品價格、病人數、平均就診次數、每次就診藥品日劑當量數及餘數。六年期間，降血壓藥物的費用成長了102%，主要來自於病人數及每次就診藥品日劑量數的增加，分別為34%及33%。其他的因素會由餘數的變異中呈現，餘數效應僅為7%。若再進一步探討其他的因素，可以發現原開發廠藥品有11%的成長，而學名藥品為12%。另一方面，醫院部分可以觀察到11%的成長，相反地，基層診所卻呈現11%的減少。此一變異或許顯示醫院中的醫師處方較多屬創新性的藥品，而基層診所的醫師則使用較多不具專利的學名藥品。

Antihypertensive medications have represented a tremendous financial burden to the health care plan globally. The utilization pattern of the antihypertensive agents was examined in this study to analyze the underlying reasons responsible for the pharmaceutical expenditure in Taiwan during 1997 to 2002. The claims data were obtained from National Health Insurance Research Database (NHIRD), which include ambulatory service record and prescription data of the entire population. Drug expenditure was decomposed into 5 components: relative drug price, number of patients treated, average physician visit per patient, defined daily dose (DDD) per physician visit and a residual. Total antihypertensive drug spending increased 102% during this period, mainly due to the compounding effect from the increment of patients treated (34%) and DDD per physician visit (33%). The aggregate residual for antihypertensive agents only exerts a 7% effect. Detailed residual analysis revealed that the brand-name product did have 11% increment, while the generic product had a 12% decrement. It also showed that hospital sector had a positive 11% residual, while primary care clinics had an 11% decrement. The most important factors that contribute to the expenditure surge of antihypertensive agents are the number of treated patients and DDD per physician visit. While physicians at the hospital sector adopted more new and innovative medications, their counterparts at the primary care clinics tended to switch some off-patent products to the generics.