邮购药品的现状及监管难点分析

随着网络的快速发展,邮购药品也作为新兴购药方式快速发展起来。当前药品管理法规中暂无有效针对药品转运过程的制约条款,药品转运过程监管规范缺失。为确保邮购药品流通环节安全可控,本文通过邮购药品的发展现状和安全监管的难点分析,找出改进监管的对策建议,为邮购药品的安全可控建言献计。     

Pharmacoeconomic aspects of poor adherence: can better adherence reduce healthcare costs?

Abstract

Background:

Poor adherence to medical treatment is one of the main reasons why patients do not achieve the full benefits of their therapy. It also has a substantial financial weight in terms of money wasted for unused medication and increased healthcare costs including hospitalization due to clinical complications.

Objective:

To provide an overview and examples of the financial and economic consequences of poor adherence to treatment, techniques and devices for monitoring adherence and interventions for improvement of treatment adherence.

Results:

New electronic devices with monitoring features may help to objectively monitor patients’ adherence to a treatment regimen that can help a healthcare professional determine how to intervene to improve adherence and subsequent clinical outcome. Interventions that aim to enhance adherence may confer cost-effectiveness benefits in some indications and settings. The nature of the intervention(s) used depends on a range of factors, including patient preference, therapy area and cost of the intervention. However, there is a pressing need for rigorous trials, as current studies often have major flaws in the economic methodology, especially in terms of incremental analysis and sensitivity analysis.

Limitations:

This review has focused on a limited number of therapeutic areas as coverage of a more extensive range of diseases may be beyond the scope of such a summary. Nevertheless, the examples are representative of the challenges encountered in many other diseases.

Conclusions:

The clinical and economic consequences of non-adherence and interventions to improve compliance reflect the nature and severity of non-adherence, as well as the pathophysiology and severity of the disease. Interventions that aim to enhance adherence may confer cost-effectiveness benefits in some indications and settings, and good adherence can help payers and providers contain costs by extracting maximum value from their investment in therapies.     

Medicare patient experience with vagus nerve stimulation for treatment-resistant depression

Abstract

Background:

Major depressive disease (MDD) represents a cost burden to the US healthcare system: approximately one-third of MDD patients fail conventional treatment: multiple failures define treatment-resistant depression (TRD). Vagus nerve stimulation (VNS) therapy is an approved adjunctive treatment for TRD.     

The Challenge of Humanistic Economics

The Center for Medicare and Medicaid Services (CMS) created the Hospital Compare Program in 2003 to increase transparency between healthcare providers and consumers. Implemented in 2005, this transparency consists of hospitals' collecting and making publicly available a set of hospital quality score measures. The CMS induced participation by financially penalizing hospitals that did not publicly report a specific subset of these measures (called “starter” measures). Three years into the program, the penalty for non-reporting both the starter measures and other (“non-starter”) measures was increased. I use a difference-in-differences methodology to analyze the effect of the increased CMS penalty on the likelihood that a hospital publicly reported its starter and non-starter measure scores. I find that the penalty had an economically and statistically insignificant effect on the probability that a hospital publicly reported its starter scores, but a statistically significant 8.0 percent effect (p-value<0.01) on whether it reported its non-starter scores. These findings are robust to a series of alternative empirical specifications.     

澳大利亚基本医疗保险管理体静

澳大利亚拥有世界一流的健康服务体系。国民医疗保险作为政府主导下的全民医疗保险,保障了所有澳大利亚居民都可以获得必要的和高质量的治疗、药物及医院服务。澳大利亚政府的国民服务部负责国民医疗保险的具体管理并提供服务。同时,澳大利亚政府鼓励居民在国民医疗保险之外,积极参加私人医疗保险。94％以上的澳大利亚居民对基本医疗保险满意。通过介绍澳大利亚国民医疗保险及政府对其管理的基本情况,旨在为我国医疗保险制度的改革提供参考。     

Real-world treatment patterns and healthcare costs among biologic-naive patients initiating apremilast or biologics for the treatment of psoriasis

Objective: This study compared real-world treatment patterns and healthcare costs among biologic-naive psoriasis patients initiating apremilast or biologics.

Methods: A retrospective cohort study was conducted using the Optum Clinformatics? claims database. Patients with psoriasis were selected if they had initiated apremilast or biologics between January 1, 2014, and December 31, 2015; had 12?months of pre-index and post-index continuous enrollment in the database; and were biologic-naive. The index date was defined as the date of the first claim for apremilast or biologic, and occurred between January 1, 2014, and December 31, 2015. Treatment persistence was defined as continuous treatment without a?>?60-day gap in therapy (discontinuation) or a switch to a different psoriasis treatment during the 12-month post-index period. Adherence was defined as a medication possession ratio (MPR) of ≥ 80% while persistent on the index treatment. Persistence-based MPR was defined as the number of days with the medication on hand measured during the patients’ period of treatment persistence divided by the duration of the period of treatment persistence. Because patients were not randomized, apremilast patients were propensity score matched up to 1:2 to biologic patients to adjust for possible selection bias. Treatment persistence/adherence and all-cause healthcare costs were evaluated. Cost differences were determined using Wilcoxon rank-sum tests.

Results: In all, 343 biologic-naive patients initiating apremilast were matched to 680 biologic-naive patients initiating biologics. After matching, patient characteristics were similar between cohorts. Twelve-month treatment persistence was similar for biologic-naive patients initiating apremilast vs biologics (32.1% vs 33.2%; p?=?0.7079). While persistent on therapy up to 12?months, per-patient per-month (PPPM) total healthcare costs were significantly lower among biologic-naive cohorts initiating apremilast vs biologics ($2,214 vs $5,184; p?p?p?p?Limitations: Data were limited to individuals with United Healthcare commercial and Medicare Advantage insurance plans, and may not be generalizable to psoriasis patients with other insurance or without health insurance coverage.

Conclusion: Biologic-naive patients with similar patient characteristics receiving apremilast vs biologics had significantly lower PPPM costs, even when they switched to biologics during the 12-month post-index period. These results may be useful to payers and providers seeking to optimize psoriasis care while reducing healthcare costs.     

谈生物技术专业药学实验教学改革

为适应21世纪生物经济发展趋势,培养21世纪新型生物技术人才,结合我校实际,通过提高实验课时所占总课时的比例,增加实验课的内容,整合药学相关实验资源,结合综合性实验、设计性实验、创新性实验,改革＂理论-实践＂的教学环节,多指标综合评分考核等对药学实验教学进行改革,获得新型药学实验教学模式。     

Economics in Disarray

In 1963, the North Dakota Legislature amended the North Dakota Century Code to ensure that all licensed community pharmacies in the State are majority owned by pharmacists registered in the State. During the 2008-2009 legislative session, a debate arose about whether this law should be repealed. Those in favor of repeal attacked the law using the neoclassical arguments of efficiency, competition and lower prices. Those opposed to the law's repeal argued that pharmacists must own pharmacies in order to protect the public's welfare. This paper explores the arguments made for and against this law and draws two major conclusions. First, the arguments made by both sides are flawed because neither side fully incorporates the historical, physical and cultural characteristics of North Dakota communities into their analyses. Second, North Dakota legislators voted overwhelmingly to retain the law. Moreover, prima fascia evidence indicates that the legislators based their decisions on Institutional considerations.