提示: 手机请竖屏浏览!

开展预防性干预计划——转变模式的时机已到
Deployment of Preventive Interventions — Time for a Paradigm Shift


Katherine Pryor ... 其他 • 2018.05.10

2002年,Knowler等人报告了一项具有里程碑意义的研究结果,那是一项大型随机对照试验,对采用行为干预和药物治疗预防糖尿病进行了比较1。在平均2.8年的随访期内,在空腹和餐后血糖升高的人中,与安慰剂相比,被称为糖尿病预防计划(Diabetes Prevention Program,DPP)的生活方式改善计划使糖尿病发病率降低了58%。与安慰剂相比,二甲双胍使糖尿病发病率降低了31%。

尽管有这样的研究结果,但在将医疗保险覆盖到与DPP类似的干预计划方面,保险公司的进展缓慢。2016年,美国老年医疗保险和医疗补助保险服务中心(Centers for Medicare and Medicaid Services)对该计划进行了试点,结果发现该计划提高了患者医疗质量,减少了美国老年医疗保险的净支出,这促使其制订了到2018年将DPP扩大到全国范围的目标。尽管自从1995年二甲双胍在美国上市以来,医疗保险已经普遍覆盖二甲双胍,但仅在最近,许多私营保险公司才开始将DPP列入保险覆盖范围。 





作者信息

Katherine Pryor, M.D., and Kevin Volpp, M.D., Ph.D.
From the Center for Health Incentives and Behavioral Economics, and the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia.

 

参考文献

1. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393-403.

2. Chambers JD, Cangelosi MJ, Neumann PJ. Medicare’s use of cost-effectiveness analysis for prevention (but not for treatment). Health Policy 2015;119:156-163.

3. Chambers JD, Lord J, Cohen JT, Neumann PJ, Buxton MJ. Illustrating potential efficiency gains from using cost-effectiveness evidence to reallocate Medicare expenditures. Value Health 2013;16:629-638.

4. Kent DM, Nelson J, Dahabreh IJ, Rothwell PM, Altman DG, Hayward RA. Risk and treatment effect heterogeneity: re-analysis of individual participant data from 32 large clinical trials. Int J Epidemiol 2016;45:2075-2088.

5. Castro Sweet CM, Chiguluri V, Gumpina R, et al. Outcomes of a digital health program with human coaching for diabetes risk reduction in a Medicare population. J Aging Health 2017 January 1 (Epub ahead of print).

服务条款 | 隐私政策 | 联系我们