Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA.
Health Serv Res. 2011 Dec;46(6pt1):1963-85. doi: 10.1111/j.1475-6773.2011.01286.x. Epub 2011 Jun 20.
To compare changes in medication adherence between patients with high- or low-comorbidity burden after a copayment increase.
We conducted a retrospective observational study at four Veterans Affairs (VA) medical centers by comparing veterans with hypertension or diabetes required to pay copayments with propensity score-matched veterans exempt from copayments. Disease cohorts were stratified by Diagnostic Cost Group risk score: low- (<1) and high-comorbidity (>1) burden. Medication adherence from February 2001 to December 2003, constructed from VA pharmacy claims data based on the ReComp algorithm, were assessed using generalized estimating equations.
Veterans with lower comorbidity were more responsive to a U.S.$5 copayment increase than higher comorbidity veterans. In the lower comorbidity groups, veterans with diabetes had a greater reduction in adherence than veterans with hypertension. Adherence trends were similar for copayment-exempt and nonexempt veterans with higher comorbidity.
Medication copayment increases are associated with different impacts for low- and high-risk patients. High-risk patients incur greater out-of-pocket costs from continued adherence, while low-risk patients put themselves at increased risk for adverse health events due to greater nonadherence.
比较共付额增加后高或低合并症负担患者的药物治疗依从性变化。
我们在四个退伍军人事务部（VA）医疗中心进行了一项回顾性观察性研究，通过比较需要支付共付额的高血压或糖尿病退伍军人与无需支付共付额的倾向评分匹配退伍军人，比较共付额增加后高或低合并症负担患者的药物治疗依从性变化。疾病队列根据诊断成本组风险评分分层：低（<1）和高（>1）合并症负担。使用广义估计方程，根据 ReComp 算法从 VA 药房索赔数据中构建 2001 年 2 月至 2003 年 12 月的药物治疗依从性。
与高合并症退伍军人相比，低合并症退伍军人对 5 美元的共付额增加更敏感。在低合并症组中，糖尿病退伍军人的依从性下降幅度大于高血压退伍军人。对于高合并症的共付豁免和非豁免退伍军人，依从性趋势相似。
药物共付额增加对低风险和高风险患者的影响不同。高风险患者由于继续用药而产生更多的自付费用，而低风险患者由于不依从而增加不良健康事件的风险。
