Miller G Edward, Sarpong Eric M, Hill Steven C
Division of Modeling and Simulation, Center for Financing, Access and Cost Trends Agency for Healthcare Research and Quality, Rockville, Maryland, USA.
J Diabetes. 2015 Nov;7(6):872-80. doi: 10.1111/1753-0407.12292. Epub 2015 May 6.
The aim of the present study was to investigate increased out-of-pocket drug costs and financial burdens of achieving adherence to oral antidiabetic medications and medications for prevalent comorbidities.
Concurrent adherence to medications, out-of-pocket drug costs, and financial burdens were measured among non-elderly adults with diabetes in the Medical Expenditure Panel Survey. "Financial burden" was defined as spending on health care exceeding 10% of family income. This study simulated the increased out-of-pocket drug costs and financial burdens that would result if non-adherent adults in our sample had obtained sufficient medications to be adherent. For each adult, for all therapeutic classes in which they were non-adherent, we calculated the additional days supplied required to become adherent, as well as out-of-pocket spending on these additional days supplied.
Approximately one-quarter adhered to all required medications. Among non-adherent adults with employer-sponsored insurance and public insurance, the mean annual out-of-pocket drug costs of achieving adherence were US$171 and US$68, respectively, which was generally affordable. However, 35.6% of the uninsured lived in families that spent 10% or more of their income on health care. Mean simulated additional out-of-pocket drug costs of achieving adherence were US$310 for the uninsured. These additional drug costs would increase those spending 10% or more of income to 39.6% of the uninsured.
Efforts to reduce the costs faced by the uninsured and insured will make adherence more affordable and, therefore, more attainable for some adults with diabetes.
本研究旨在调查自付药品费用的增加以及实现口服抗糖尿病药物和常见合并症药物依从性所带来的经济负担。
在医疗支出面板调查中，对非老年糖尿病成年人的药物依从性、自付药品费用和经济负担进行了同时测量。“经济负担”定义为医疗保健支出超过家庭收入的10%。本研究模拟了如果我们样本中的非依从性成年人获得足够的药物以实现依从性，自付药品费用和经济负担将会增加的情况。对于每一位成年人，对于他们未依从的所有治疗类别，我们计算了实现依从性所需额外供应的天数，以及这些额外供应天数的自付费用。
约四分之一的人坚持服用所有所需药物。在有雇主赞助保险和公共保险的非依从性成年人中，实现依从性的年均自付药品费用分别为171美元和68美元，总体上是可以承受的。然而，35.6%的未参保者所在家庭将其收入的10%或更多用于医疗保健。未参保者实现依从性的模拟平均额外自付药品费用为310美元。这些额外的药品费用将使那些将收入的10%或更多用于医疗保健的未参保者比例增至39.6%。
降低未参保者和参保者所面临成本的努力将使依从性对一些糖尿病成年人来说更具可承受性，因此也更有可能实现。
