健保放寬降血脂藥物給付範圍對心血管疾病發生率及費用之影響

The impact of expansion of dyslipidemia drug coverage on cardiovascular disease incidence and costs under the National Health Insurance scheme

目標：全民健保於2013年8月1日放寬高危險族群使用降血脂藥物的給付規定，本研究旨探討該政策對於心血管疾病發生率與醫療費用之影響。方法：使用全民健康保險全人口資料庫進行分析，針對用藥給付放寬的範圍去界定研究與對照組，選取無心血管疾病史的糖尿病患者118,912人為研究組|無心血管疾病史且無糖尿病史的高血壓患者150,930人為對照組。追蹤觀察期為2013年8月1日前後各3年。統計分析採用差異中的差異法，檢視政策實施前後，兩組病人在降血脂藥物開立、心血管疾病（急性心肌梗塞與缺血性腦中風）發生、及醫療花費的差異。結果：研究發現在政策實施後，研究組的病人比對照組較容易獲得降血脂藥物的開立（OR=1.095,p<0.0001），其心血管疾病的發生機率也較低（OR=0.914,p=0.0046），且降血脂藥物費用較低（β=—0.016,p=0.0019），而心血管疾病的花費雖然有比較低，但未達統計上的顯著差異（β=—0.087,p=0.1504）。結論：2013年的放寬降血脂給付政策讓高風險族群的糖尿病患者的用藥人數上升、心血管疾病發生趨緩，但尚未見可以節省健保花費，建議未來可以做更長期的觀察評估。（台灣衛誌2020|39(3)：269—277）
Objectives: Aiming to reduce the occurrence of cardiovascular disease (CVD), Taiwan's National Health Insurance (NHI) Administration expanded coverage for hypolipidemic drugs for high-risk patients, including patients with a history of CVD or diabetes in 2013. This study intended to evaluate the impact of this policy. Methods: Patients with diabetes but without a history of CVD (118,912 subjects) were selected as the study group, and patients with hypertension but without a history of CVD or diabetes (150,930 subjects) were the comparison group. Using August 1, 2013, as the cut-off point we defined 3 years each in the pre- and postpolicy periods. Generalized estimation equation (GEE) models with a difference-in-differences analysis were used to estimate the effects of the new policy in 2010 and 2016. Outcome variables included the likelihood of receiving hypolipidemic drugs, occurrence of CVD (acute myocardial infarction and ischemic stroke), and expenses for drugs and CVD. Results: After introduction of the policy, subjects in the study group were more likely to receive hypolipidemic drugs (OR=1.095, p<0.001), and less likely to have CVD (OR=0.914, p=0.0046) than subjects in the comparison group. The subjects in the study group also had lower expenses for hypolipidemic drugs (β=-0.016, p=0.0019), but the lower expenses for CVD did not reach the significance level (β=-0.087, p=0.1504). Conclusions: The expanded coverage for hypolipidemic drugs significantly increased the use of medications for high-risk patients, and reduced the occurrence of CVD in Taiwan. Long-tern evaluation of this medication policy is recommended. (Taiwan J Public Health. 2020|39(3):269-277)