Association of Medicare's Bundled Payment Reform With Changes in Use of Vitamin D Among Patients Receiving Maintenance Hemodialysis: An Interrupted Time-Series Analysis.
Am J Kidney Dis
; 72(2): 178-187, 2018 08.
Article
em En
| MEDLINE
| ID: mdl-29891194
ABSTRACT
BACKGROUND & RATIONALE Medicare's 2011 prospective payment system (PPS) was introduced to curb overuse of separately billable injectable drugs. After epoietin, intravenous (IV) vitamin D analogues are the biggest drug cost drivers in hemodialysis (HD) patients, but the association between PPS introduction and vitamin D therapy has been scarcely investigated. STUDY DESIGN:
Interrupted time-series analyses. SETTING &PARTICIPANTS:
Adult US HD patients represented in the US Renal Data System between 2008 and 2013. EXPOSURES PPS implementation.OUTCOMES:
The cumulative dose of IV vitamin D analogues (paricalcitol equivalents) per patient per calendar quarter in prevalent HD patients. The average starting dose of IV vitamin D analogues and quarterly rates of new vitamin D use (initiations/100 person-months) in incident HD patients within 90 days of beginning HD therapy. ANALYTICALAPPROACH:
Segmented linear regression models of the immediate change and slope change over time of vitamin D use after PPS implementation.RESULTS:
Among 359,600 prevalent HD patients, IV vitamin D analogues accounted for 99% of the total use, and this trend was unchanged over time. PPS resulted in an immediate 7% decline in the average dose of IV vitamin D analogues (average baseline dose = 186.5 µg per quarter; immediate change = -13.5 µg [P < 0.001]; slope change = 0.43 per quarter [P = 0.3]) and in the starting dose of IV vitamin D analogues in incident HD patients (average baseline starting dose = 5.22 µg; immediate change = -0.40 µg [P < 0.001]; slope change = -0.03 per quarter [P = 0.03]). The baseline rate of vitamin D therapy initiation among 99,970 incident HD patients was 44.9/100 person-months and decreased over time, even before PPS implementation (pre-PPS ß = -0.46/100 person-months [P < 0.001]; slope change = -0.19/100 person-months [P = 0.2]). PPS implementation was associated with an immediate change in initiation levels (by -4.5/100 person-months; P < 0.001).LIMITATIONS:
Incident HD patients were restricted to those 65 years or older.CONCLUSION:
PPS implementation was associated with a 7% reduction in the average dose and starting dose of IV vitamin D analogues and a 10% reduction in the rate of vitamin D therapy initiation.Palavras-chave
Medicare; United States Renal Data System (USRDS); Vitamin D; bundled payment; calcitriol; doxercalciferol; drug costs; end-stage renal disease (ESRD); hemodialysis (HD); interrupted time-series; intravenous preparation; observational; oral preparation; paricalcitol; payment reform; prospective payment system (PPS); vitamin D analogs
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Vitamina D
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Sistema de Pagamento Prospectivo
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Medicare
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Diálise Renal
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Análise de Séries Temporais Interrompida
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Falência Renal Crônica
Tipo de estudo:
Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
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Female
/
Humans
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Male
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Am J Kidney Dis
Ano de publicação:
2018
Tipo de documento:
Article