Department of Clinical Pharmacy and Translational Science, University of Tennessee College of Pharmacy, Memphis, TN, USA.
Pharmaceutical Research and Manufacturers of America (PhRMA), Washington, DC, USA.
Value Health. 2020 Sep;23(9):1210-1217. doi: 10.1016/j.jval.2020.06.005. Epub 2020 Aug 5.
Significant literature exists on the effects of medication adherence on reducing healthcare costs, but less is known about the effect of medication adherence among Medicare low-income subsidy (LIS) recipients. This study examined the effects of medication adherence on healthcare costs among LIS recipients with diabetes, hypertension, and/or heart failure.
This retrospective study analyzed Medicare claims data (2012-2013) linked to the Area Health Resources Files. Using measures developed by the Pharmacy Quality Alliance, adherence to 11 medication classes was studied among patients with 7 possible combinations of the diseases mentioned. Adherence was measured in 8 categories of proportion of days covered (PDC): ≥95%, 90% to <95%, 85% to <90%, 80% to <85%, 75% to <80%, 50% to <75%, 25% to <50%, and <25%. Annual Medicare costs were compared across adherence categories. A generalized linear model was used to control for patient/community characteristics.
Among patients with only one disease, such as diabetes, patients with the lowest adherence (PDC < 25%) had $3152/year higher Medicare costs than patients with the highest adherence (PDC ≥ 95%; $11 101 vs $7949; P < .05). The adjusted costs among patients with PDC < 25% was $1893 higher than patients with PDC ≥ 95% ($9919 vs $8026; P < .05). Among patients with multiple chronic conditions, patients' adherence to medications for fewer diseases had higher costs.
Greater medication adherence is associated with lower Medicare costs in the Medicare LIS population. Future policy affecting the LIS program should encourage better medication adherence among patients with chronic diseases.
关于药物依从性降低医疗成本的影响，已有大量文献记载，但对于医疗保险低收入补贴（LIS）受助人药物依从性的影响知之甚少。本研究调查了药物依从性对患有糖尿病、高血压和/或心力衰竭的 LIS 受者医疗成本的影响。
本回顾性研究分析了医疗保险索赔数据（2012-2013 年）与区域卫生资源文件的关联。使用药房质量联盟制定的措施，研究了 7 种可能的疾病组合中患者的 11 种药物类别的依从性。依从性在 8 个比例天数覆盖（PDC）类别中进行测量：≥95%、90%至<95%、85%至<90%、80%至<85%、75%至<80%、50%至<75%、25%至<50%和<25%。比较了不同依从性类别的年度医疗保险费用。使用广义线性模型控制患者/社区特征。
在只有一种疾病的患者中，例如糖尿病，依从性最低（PDC < 25%）的患者比依从性最高（PDC ≥ 95%）的患者的医疗保险费用高出 3152 美元/年（$11101 与$7949；P <.05）。PDC<25%的患者的调整费用比 PDC≥95%的患者高 1893 美元（$9919 与$8026；P <.05）。在患有多种慢性病的患者中，药物治疗的疾病种类越少，患者的依从性越高，费用也越高。
在医疗保险 LIS 人群中，更高的药物依从性与更低的医疗保险费用相关。未来影响 LIS 计划的政策应鼓励慢性病患者更好地遵守药物治疗。
