从支付方角度看糖尿病成人泌尿道和皮肤及软组织感染的成本，以及其与口服抗糖尿病药物不依从的关系。
A Payer Perspective of the Costs of Urinary Tract and Skin and Soft Tissue Infections in Adults with Diabetes and the Relationship to Oral Antidiabetic Medication Nonadherence.
机构信息
Indiana University School of Nursing, Bloomington.
Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University, Richmond.
出版信息
J Manag Care Spec Pharm. 2019 Dec;25(12):1409-1419. doi: 10.18553/jmcp.2019.19052. Epub 2019 Aug 22.
BACKGROUND
Controlling costs and improving quality outcomes are important considerations of the triple aim in health care. Medication adherence to oral antidiabetic (OAD) medications is an outcome measure for those with diabetes. However, there is little research reporting the costs associated with OAD medication adherence among adults with diabetes and comorbid infections.
OBJECTIVE
To provide nationally representative cost and utilization estimates from a payer perspective of 2 common comorbid infections: urinary tract infection (UTI) and skin and soft tissue infection (SSTI) among adults with diabetes in relation to OAD medication nonadherence to quantify cost per outcome.
METHODS
A retrospective observational study for years 2010-2015 used longitudinal panel data in the public domain from the Medical Expenditure Panel Survey (MEPS). The study included individuals aged ≥ 18 years with diabetes (excluding gestational diabetes) who were prescribed OAD medications and then stratified by infection status, that is, without infection versus with UTI and/or SSTI. Outcomes measured included medication adherence, defined as medication possession ratio (MPR); treated prevalence of UTI and SSTI; and associated direct medical costs paid by insurers.
RESULTS
4,633 adults with diabetes were included; of those, 12% reported a UTI or SSTI, with the weighted sample representing 2.2 million U.S. residents. The mean MPR was 0.61 and 0.63 in the infection and noninfection groups, respectively. Less than 35% in each group were adherent to OAD medications. Having a UTI or SSTI increased the adjusted total health expenses by 53.7% ( < 0.001), but adherence to OAD medications did not significantly affect total health care costs.
CONCLUSIONS
In adults with diabetes, a UTI or SSTI diagnosis did not influence medication adherence to OAD medication but increased health care utilization and costs significantly.
DISCLOSURES
This study was supported by the Virginia Commonwealth University Presidential Research Quest Fund (PeRQ Fund). The authors have no financial conflicts of interest to disclose.
背景
控制成本和提高医疗质量是医疗保健三重目标的重要考虑因素。糖尿病患者的药物依从性是口服抗糖尿病（OAD）药物治疗的一个结果衡量指标。然而，关于糖尿病合并感染患者的 OAD 药物依从性相关成本的研究很少。
目的
从支付者的角度提供全国代表性的成本和利用估计，评估 2 种常见合并感染（糖尿病患者中的尿路感染（UTI）和皮肤和软组织感染（SSTI））与 OAD 药物不依从性的关系，以量化每例患者的成本。
方法
这项回顾性观察性研究使用了公共领域的 2010-2015 年医疗支出调查（MEPS）的纵向面板数据。研究纳入了年龄≥18 岁、服用 OAD 药物且患有糖尿病（不包括妊娠糖尿病）的患者，然后根据感染情况分层，即无感染与有 UTI 和/或 SSTI。测量的结果包括药物依从性，定义为用药比例（MPR）；经治疗的 UTI 和 SSTI 流行率；以及保险公司支付的相关直接医疗费用。
结果
共纳入 4633 名糖尿病患者；其中 12%的患者报告患有 UTI 或 SSTI，加权样本代表了 220 万美国居民。感染组和非感染组的平均 MPR 分别为 0.61 和 0.63。每组不到 35%的患者依从 OAD 药物治疗。患有 UTI 或 SSTI 会使调整后的总健康费用增加 53.7%（<0.001），但 OAD 药物的依从性对总医疗费用没有显著影响。
结论
在患有糖尿病的成年人中，UTI 或 SSTI 诊断不会影响 OAD 药物的依从性，但会显著增加医疗保健的利用和成本。
披露
这项研究得到了弗吉尼亚联邦大学总统研究探索基金（PeRQ Fund）的支持。作者没有财务利益冲突需要披露。
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