College of Pharmacy University of Arizona Tucson AZ.
Pharmacy Quality Alliance, Inc. Alexandria VA.
J Am Heart Assoc. 2020 Sep;9(17):e016094. doi: 10.1161/JAHA.119.016094. Epub 2020 Aug 26.
Background Medication non-adherence can result in considerable morbidity, mortality, and costs. The Pharmacy Quality Alliance hypertension medication adherence measure is used by US healthcare payers and providers to assess renin-angiotensin system antagonist medication adherence. However, associations between renin-angiotensin system antagonist adherence as calculated in quality measures, and healthcare service use and expenditure in commercial populations over a 1-year timeframe has not been assessed. Methods and Results This retrospective cohort study used eligible commercially insured individuals from the Truven Health MarketScan Commercial Claims and Encounters Research Databases (2009-2015). Generalized linear models with log link and gamma distribution (expenditure) or negative binomial distribution (usage) assessed relationships between hypertension adherence (≥80% proportion of days covered) and healthcare use and expenditures (in 2015 US dollars) while adjusting for covariates (age, sex, geographic region; health plan; Deyo-Charlson Comorbidity Index, number of chronic medications, and treatment naivety). Beta coefficients were used to compute cost ratios and rate ratios. A total of 4 842 058 subjects were eligible; of those, 3 310 360 (68%) were adherent (adherent mean age 53.3±8.0 years, 55.9% men; non-adherent mean age 50.3±9.1 years, 53.1% men). Adherence was associated with fewer inpatient (rate ratios, 0.612; 95% CI, 0.607-0.617) and outpatient visits (rate ratios, 0.995; 95% CI, 0.994-0.997); and lower total costs (cost ratios, 0.876; 95% CI, 0.874-0.878) compared with non-adherence. Adherence was associated with lower average per member per month total costs ($97.98) compared with non-adherence. Conclusions Adherence to renin-angiotensin system antagonists was associated with fewer outpatient and inpatient visits, and lower total costs compared with non-adherence in a 1-year time frame.
背景 药物不依从会导致相当大的发病率、死亡率和成本。美国医疗保健支付者和提供者使用药房质量联盟高血压药物依从性措施来评估肾素-血管紧张素系统拮抗剂药物的依从性。然而，在 1 年时间内，质量措施中计算出的肾素-血管紧张素系统拮抗剂的依从性与商业人群的医疗服务使用和支出之间的关联尚未得到评估。
方法和结果 这项回顾性队列研究使用了 Truven Health MarketScan 商业索赔和就诊研究数据库（2009-2015 年）中符合条件的商业保险个体。使用广义线性模型，对数链接和伽马分布（支出）或负二项分布（使用）来评估高血压依从性（≥80%的天数覆盖率）与医疗保健使用和支出（以 2015 年美元计算）之间的关系，同时调整协变量（年龄、性别、地理位置；健康计划；Deyo-Charlson 合并症指数、慢性药物数量和治疗初治）。使用β系数计算成本比和费率比。共有 4 842 058 名受试者符合条件；其中，3 310 360 名（68%）为依从者（依从者平均年龄 53.3±8.0 岁，55.9%为男性；不依从者平均年龄 50.3±9.1 岁，53.1%为男性）。与不依从相比，依从性与较少的住院（比率比，0.612；95%置信区间，0.607-0.617）和门诊就诊（比率比，0.995；95%置信区间，0.994-0.997）有关；总费用也较低（成本比，0.876；95%置信区间，0.874-0.878）。与不依从相比，依从者的每个成员每月平均总费用（$97.98）较低。
结论 在 1 年时间内，与不依从相比，肾素-血管紧张素系统拮抗剂的依从性与较少的门诊和住院就诊以及较低的总费用相关。
