Ryan John G, Fedders Mark, Jennings Terri, Vittoria Isabel, Yanes Melissa
Department of Family Medicine and Community Health, University of Miami Miller School of Medicine, Miami, Florida.
Department of Family Medicine and Community Health, University of Miami Miller School of Medicine, Miami, Florida.
Clin Ther. 2014 Dec 1;36(12):1991-2002. doi: 10.1016/j.clinthera.2014.09.001. Epub 2014 Oct 2.
The extent to which reducing cost-related barriers affects diabetes outcomes and medication adherence among uninsured patients is not known. The purpose of these analyses was to understand the clinical impact and cost considerations of a prescription assistance program targeting low-income, minority patients with diabetes and at high risk for cost-related medication nonadherence.
Patients received diabetes medications without copayments for 12 months. Change in diabetes control was calculated by using glycosylated hemoglobin (HbA1c) level at follow-up compared with baseline. Clinical data were collected from the electronic health record. Medication adherence for diabetes medications was estimated by using proportion of days covered (PDC). Incremental acquisition and per-patient costs, based on actual hospital medication costs, were calculated for different baseline HbA1c levels.
Patients with baseline HbA1c levels ≥7%, ≥8%, and ≥9% experienced mean HbA1c reductions of 0.82% (P = 0.008), 1.02% (P = 0.010), and 1.47% (P = 0.010), respectively, during the 12-month period. The average PDC was 70.55%; 45.24% had a PDC ≥80%, indicating an adequate level of medication adherence. Medication adherence ≥80% was associated with ethnicity (P = 0.015), whereas mean PDC was associated with number of diabetes medication classes used (P = 0.031). Acquisition cost for 1242 prescriptions filled by 103 patients was $13,365.82, representing per-patient costs of $132.39; however, as baseline targets increased, acquisition costs decreased and per-patient costs increased from $10,682.59 and $169.56 to $6509.91 and $192.27, respectively.
Clinically significant reductions in HbA1c levels were achieved for all patients, although greater reductions were achieved with modest per-patient cost increases when considering patients with uncontrolled diabetes. Incorporating a multifactorial intervention to address cost-related medication nonadherence with a behavior change component may yield greater reductions in HbA1c with improved diabetes outcomes and meaningful hospital-based cost savings.
降低与费用相关的障碍对未参保患者的糖尿病治疗效果和药物依从性的影响程度尚不清楚。这些分析的目的是了解一项针对低收入、患有糖尿病且有与费用相关的药物治疗不依从高风险的少数族裔患者的处方援助计划的临床影响和成本考量。
患者在12个月内无需自付费用即可获得糖尿病药物。通过比较随访时与基线时的糖化血红蛋白（HbA1c）水平来计算糖尿病控制情况的变化。临床数据从电子健康记录中收集。使用药物覆盖天数比例（PDC）来估计糖尿病药物的依从性。根据实际医院药物成本，计算不同基线HbA1c水平下的增量采购成本和人均成本。
基线HbA1c水平≥7%、≥8%和≥9%的患者在12个月期间的HbA1c平均降幅分别为0.82%（P = 0.008）、1.02%（P = 0.010）和1.47%（P = 0.010）。平均PDC为70.55%；45.24%的患者PDC≥80%，表明药物依从性处于适当水平。药物依从性≥80%与种族有关（P = 0.015），而平均PDC与使用的糖尿病药物类别数量有关（P = 0.031）。103名患者开具的1242张处方的采购成本为13365.82美元，人均成本为132.39美元；然而，随着基线目标的提高，采购成本降低，人均成本分别从10682.59美元和169.56美元增加到6509.91美元和192.27美元。
所有患者的HbA1c水平均实现了具有临床意义的降低，不过在考虑糖尿病未得到控制的患者时，人均成本适度增加可实现更大幅度的降低。纳入一项多因素干预措施，以解决与费用相关的药物治疗不依从问题并包含行为改变部分，可能会使HbA1c进一步降低，改善糖尿病治疗效果，并在医院层面实现可观 的成本节约。
