| アブストラクト | BACKGROUND: In April/2009, the UK National Health Service initiated four Better Care Better Value (BCBV) prescribing indicators, one of which encouraged the prescribing of cheaper angiotensin-converting enzyme inhibitors (ACEIs) instead of expensive angiotensin receptor blockers (ARBs), with 80 % ACEIs/20 % ARBs as a proposed, and achievable target. The policy was intended to save costs without affecting patient outcomes. However, little is known about the actual impact of the BCBV indicator on ACEIs/ARBs utilisation and cost-savings. Therefore, this study aimed to evaluate the impact of BCBV policy on ACEIs/ARBs utilisation and cost-savings, including exploration of regional variations of the policy's impact. METHODS: This cross-sectional study used data from the UK Clinical Practice Research Datalink. Segmented time-series analysis was applied to monthly ACEIs prescription proportion, adjusted number of ACEIs/ARBs prescriptions and costs. RESULTS: Overall, the proportion of ACEIs prescription decreased during the study period from 71.2% in April/2006 to 70.7% in March/2012, with a small but a statistically significant pre-policy reduction in its monthly trend of 0.02% (p < 0.001). Instantly after its initiation, the policy was associated with a sudden reduction in the proportion of ACEIs prescription; however, it resulted in a statistically significant increase in the post-policy monthly trend of ACEIs prescription proportion of 0.013% (p < 0.001), resulting in an overall post-policy slope of -0.007%. Despite this post-policy induced increment, the policy failed to achieve the 80% target, which resulted in missing a potential cost-saving opportunity. The pre-policy trend of the adjusted number of ACEIs/ARBs prescriptions was increasing; however, their trends declined after the policy implementation. The policy affected neither total ACEIs/ARBs cost nor individual ACEIs or ARBs costs. CONCLUSIONS: ACEIs/ARBs utilisation was not affected by the BCBV policy. The small increase in post-policy ACEIs prescription proportion was not associated with any savings. This study represents a case study of a failed or ineffective policy and thus provides key learning lessons for other healthcare authorities. Given the existing opportunity of potential cost-savings from achieving the 80 % target, specific measures would be needed to enhance the policy implementation and uptake; however, this must be balanced against other cost-saving policies in other high-priority areas. |
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| ジャーナル名 | BMC health services research |
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| 投稿日 | 2015/9/12 |
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| 投稿者 | Baker, Amanj; Chen, Li-Chia; Elliott, Rachel A; Godman, Brian |
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| 組織名 | Division for Social Research in Medicines and Health, School of Pharmacy,;University of Nottingham, East Drive, University Park, Nottingham, NG7 2RD, UK.;paxaib@nottingham.ac.uk.;Department of Pharmacology, College of Pharmacy, Hawler Medical University,;Erbil, Iraq. paxaib@nottingham.ac.uk.;Li-Chia.Chen@nottingham.ac.uk.;Rachel.Elliott@nottingham.ac.uk.;Division of Clinical Pharmacology, Karolinska Institute, Karolinska University;Hospital, Huddinge, Stockholm, Sweden. briangodman@btinternet.com.;Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde;University, Glasgow, UK. briangodman@btinternet.com. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/26359265/ |
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