Pesa Jacqueline A, Van Den Bos Jill, Gray Travis, Hartsig Colleen, McQueen Robert Brett, Saseen Joseph J, Nair Kavita V
Janssen Scientific Affairs, LLC, Louisville, CO, USA.
Patient Prefer Adherence. 2012;6:63-72. doi: 10.2147/PPA.S28396. Epub 2012 Jan 18.
To assess the impact of patient cost-sharing for antihypertensive medications on the proportion of days covered (PDC) by antihypertensive medications, medical utilization, and health care expenditures among commercially insured individuals assigned to different risk categories.
Participants were identified from the Consolidated Health Cost Guidelines (CHCG) database (January 1, 2006-December 31, 2008) based on a diagnosis (index) claim for hypertension, continuous enrollment ≥12 months pre- and post-index, and no prior claims for antihypertensive medications. Participants were assigned to: low-risk group (no comorbidities), high-risk group (1+ selected comorbidities), or very high-risk group (prior hospitalization for 1+ selected comorbidities). The relationship between patient cost sharing and PDC by antihypertensive medications was assessed using standard linear regression models, controlling for risk group membership, and various demographic and clinical factors. The relationship between PDC and health care service utilization was subsequently examined using negative binomial regression models.
Of the 28,688 study patients, 66% were low risk. The multivariate regression model supported a relationship between patient cost sharing per 30-day fill and PDC in the following year. For every US$1.00 increase in cost sharing, PDC decreased by 1.1 days (P < 0.0001). Significant predictors of PDC included high risk, older age, gender, Charlson Comorbidity Index score, geography, and total post-index insurer- and patient-paid costs. An increase in PDC was associated with a decrease in all-cause and hypertension-related inpatient, outpatient, and emergency room visits and medical, pharmacy, and total costs.
The trend has been for managed care organizations and employers to require patients to bear a greater out-of-pocket burden for health care resources consumed. This study illustrates the potential adverse effects of higher patient cost sharing among patients with hypertension stratified by different risk levels. A decrease in PDC was predictive of higher resource utilization and health care costs, which should be of interest to payers and employers alike.
评估商业保险人群中，不同风险类别患者的降压药物费用分担对降压药物覆盖天数比例（PDC）、医疗服务利用及医疗保健支出的影响。
从综合健康成本指南（CHCG）数据库（2006年1月1日至2008年12月31日）中，根据高血压诊断（索引）索赔、索引前后连续参保≥12个月且无降压药物既往索赔记录来确定参与者。参与者被分为：低风险组（无合并症）、高风险组（一种或多种选定合并症）或极高风险组（因一种或多种选定合并症曾住院治疗）。使用标准线性回归模型评估患者费用分担与降压药物PDC之间的关系，同时控制风险组成员身份以及各种人口统计学和临床因素。随后使用负二项回归模型研究PDC与医疗服务利用之间的关系。
在28,688名研究患者中，66%为低风险。多变量回归模型支持每30天配药的患者费用分担与次年PDC之间的关系。费用分担每增加1.00美元，PDC减少1.1天（P<0.0001）。PDC的显著预测因素包括高风险、年龄较大、性别、查尔森合并症指数评分、地理位置以及索引后保险公司和患者支付的总费用。PDC的增加与全因和高血压相关的住院、门诊和急诊就诊次数以及医疗、药房和总费用的减少相关。
管理式医疗组织和雇主的趋势是要求患者为所消耗的医疗保健资源承担更大的自付负担。本研究说明了不同风险水平分层的高血压患者中，较高的患者费用分担可能产生的不利影响。PDC的降低预示着更高的资源利用和医疗保健成本，这应该引起支付方和雇主的关注。
