研究呼吁慎用贫血药物

htchb

CHICAGO — A flawed Medicare payment plan encourages aggressive use of a risky and costly anti-anemia drug on many kidney dialysis patients, say researchers who warn the system should be changed.
芝加哥——一个有缺陷的医疗保障支付计划鼓励在许多肾脏透析病人身上过度使用一种有风险又价格不菲的抗贫血药，警告该系统需要改变的研究者说道。
A new study finds that for-profit dialysis chains give higher doses of the drug than nonprofit dialysis centers. That practice may be putting patients at risk of deadly side effects, some experts said.
一个新的研究发现营利性的透析连锁（中心）比非营利性的透析中心使用更高的剂量。一些专家称，这种医疗行为可能伴有将病人推向死亡的副作用的风险。
The drug is Epogen, and Medicare pays more for it than any other single drug: $2 billion in 2005. For-profit dialysis chains report that the drug accounts for 20 percent to 25 percent of their annual net operating revenue.
该药物是促红细胞生成素，相比其他单一药物，医疗保障为其支付了更多的费用：2005年达到20亿美圆。营利性连锁中心报道该药物占其年运行收入的20%~25%。
Epogen is approved by the Food and Drug Administration to prevent blood transfusions in patients suffering from anemia, which can accompany kidney failure.
促红细胞生成素被FDA批准用在需要输血的贫血病人身上，EPO可能会导致肾衰竭（贫血的病人可能会伴随肾衰竭）。
However, its overuse has been linked to increases in deaths, strokes and heart attacks. Last month, federal regulators asked makers to place a black box warning on Epogen and other similar drugs' labels, the strongest warning a prescription drug can have.
然而该药的过度使用一直和增加的死亡、中风和卒中有关系。上个月，联邦管理者要求EPO的制造厂在EPO和其他类似药物包装上加一个黑箱标志，该标志是处方药的明显标志。
The new study found that patients in chain-operated, for-profit dialysis centers consistently are given the highest doses of Epogen, regardless of their anemia status. The for-profit centers increased the drug dose even when patients already had recommended levels of red blood cells. The nonprofit centers did not.
该项新研究发现病人在连锁运做、营利性透析中心被持续的给予最高剂量的EPO，而不是根据病人的病人状况来给药。营利性中心即使在红细胞处于推荐水平的病人身上仍然增加EPO的使用剂量。但非营利性中心并未如此。
\"atients are at risk here. They need to be reassured that the right thing is being done for them,\" said study co-author Dennis Cotter of the Medical Technology and Practice Patterns Institute, a nonprofit research group in Bethesda, Md.
“病人在这里是有风险的。他们需要被保证在他们身上所采用的医疗措施是正确的，”研究的共同作者——医疗技术和执业模式机构的丹尼斯科特说道，该机构位于麻里州百色达，是一个非营利性研究组织。
Cotter said Medicare not only reimburses dialysis centers a fixed amount for each treatment, they also reimburse them separately for Epogen.
科特说医疗保障制度不仅对血液透析中心的每项治疗偿还固定数额的费用，同时还对EPO的使用偿付。
Some for-profit chains, which handle the majority of dialysis patients, negotiate volume discounts from Epogen's drug maker, Amgen Inc. of Thousand Oaks, Calif. So the chains generally buy the drug for less than Medicare reimburses, making the drug a profit center.
一些营利性中心，这部分中心接受绝大多数的透析病人的治疗，和EPO的制造商——Amgen Inc. of Thousand Oaks达成折扣协议。这样一来，中心购入药物的价格低于医疗保障的偿付，使该药物成为利润的制造中心。
DaVita Inc., one of the chains, stated in its 2006 annual report that one-fourth of its net operating revenue comes from administering the drug. Fresenius Medical Care AG reported the drug accounts for 21 percent of its net operating revenue in North America.
其中一家连锁中心，达维塔公司，在其2006年年度报告中指出该公司四分之一的净运行收入来自于该药物的使用。Fresenius Medical Care AG 报道该药物占其在北美的净运行收入的百分之二十一。
\"If ever there was a time to fix this reimbursement system, it's now,\" said Dr. Ajay Singh of Harvard's Brigham and Women's Hospital, who was not involved in the new study, but led a previous study that linked aggressive use of the drug to health risks. Its overuse \"may put patients at higher risk,\" he said.
“现在是修改这个医疗偿付制度的时候了。” Harvard's Brigham and Women's 医院的Singh医生说到，他没有参与该项新研究，但是他曾经主持了一项研究发现过度使用EPO和健康危险有关。他说“该药的过度使用会将病人推向更高的风险。”
The differences in use between for-profit and nonprofit centers was not because certain patients were sicker, the researchers found. The study, appearing in Wednesday's Journal of the American Medical Association, is based on data on nearly 160,000 dialysis patients who got care in 2004.
研究者发现，非营利性中心和营利性中心的不同用药并不是因为病人更加严重。出现在周三的美国医院协会杂志的该项研究报道是以在2004年获得治疗的将近16万的透析病人为依据的。
In an accompanying editorial in JAMA, Dr. Daniel Coyne of Washington University School of Medicine in St. Louis said kidney doctors who work with dialysis centers may not know they are \"making dubious dosing decisions\" because they sign multipage standing orders and turn over anemia management to chain employees.
在该杂志的同期社论中，位于圣路易斯的Washington University School of Medicine的康利医生说在透析中心工作的肾内科医生可能不知道他们在“使用可疑剂量的医疗决策”，因为他们通常下几页的长期医嘱并将贫血的管理叫给连锁中心的雇工处理。
Amgen spokesman Dan Whelan said the company believes most Epogen use has been appropriate.
Amgen的发言人Dan Whelan说公司相信大多数的EPO的使用都是合适的。
\"Doctors make Epogen prescribing decisions based on the clinical needs of their patients,\" Whelan said. He said one year of Epogen treatment for a dialysis patient costs about $8,920 at wholesale.
“医生下EPO的处方是根据病人的临床需要而定的，”Whelan说。他说一年一个透析病人的EPO治疗花费总共大概在8，920美元。
Dr. Paul Scheel, director of nephrology at Johns Hopkins University Medical Center, said he doesn't believe that doctors are turning over prescribing decisions to dialysis centers or are unaware of dosing. As someone who's worked with two dialysis chains, he said he has never been encouraged to use Epogen inappropriately.
Paul Scheel医生，Johns Hopkins大学医疗中心的肾病学领导，说他不相信医生将处方决定交给透析中心或者医生们会不注意药物剂量。作为一个在2个连锁透析中心工作的人，他说他从来没有鼓励过不正确的使用EPO。
Dr. Charles McAllister, chief medical officer for DaVita, said the company's dosing guidelines \"are based on clinical science and really are done in an open collaborative atmosphere with physicians. The decision to use a guideline is purely that of the physician alone.\"
Charles McAllister医生，DaVita首席医疗长官，说公司的剂量指导“是根据临床研究而且该指导是在一个和医生公开协作的环境下完成的。使用剂量指导的决定是完全由医生来做的。”
Medicare spokeswoman Ellen Griffith said the agency expects to report to Congress this summer about its dialysis payment system and plans a demonstration project of a new payment system that would include Epogen in a \"bundled\" reimbursement rate.
医疗保障制度的发言人Ellen Griffith说该机构预期在今年夏天向国会报道透析的偿还系统，并计划同时进行一个新偿付系统的示范项目，该个将将EPO置入一个受约束的偿付率中。
Amgen supports the demonstration project, Whelan said. But Singh and Cotter said a demonstration project would only delay changes needed immediately.
Amgen公司支持该示范项目，Whelan说。但是Singh 和Cotter认为该示范项目将只会延缓需要立刻执行的改变。