Eli Lilly and Company, Indianapolis, IN, USA; Department of Pharmaceutical Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA.
Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA.
J Clin Lipidol. 2020 Nov-Dec;14(6):791-798. doi: 10.1016/j.jacl.2020.09.005. Epub 2020 Sep 22.
Adherence to statin medications is suboptimal; however, the association of statin adherence, as defined in medication adherence quality measures, with healthcare service use and expenditure within one year has not been assessed in a commercially insured United States (US) population.
To investigate the relationship between statin adherence, as specified in the Pharmacy Quality Alliance (PQA) statin medication adherence quality measure, and healthcare resource utilization and expenditures within commercial health plans over a one-year period.
This one-year retrospective analysis involved a cohort of individuals from the Truven Health MarketScan Commercial Claims and Encounters Research Databases (2009-2015). Generalized linear models with log link and negative binomial distribution (use) or gamma distribution (expenditures) were used to assess relationships between medication adherence (≥80% proportion of days covered) and healthcare use and expenditures (adjusted to 2015 US dollars) while adjusting for covariates. Beta coefficients were used to compute cost ratios (CR) and rate ratios (RR). An alpha level of 0.001 was set a priori.
Of 4,450,308 eligible individuals, 2,757,288 (61.9%) were classified as adherent. Multivariable analyses indicated adherent individuals had more outpatient (RR = 1.009, 95% CI = 1.007, 1.010) and fewer inpatient visits (RR = 0.756, 95% CI = 0.749, 0.762); and lower outpatient (CR = 0.965, 95% CI = 0.963, 0.967), inpatient (CR = 0.780, 95% CI = 0.779, 0.782), and total expenditures (CR = 0.975, 95% CI = 0.973, 0.977). Adherence was associated with lower per member per month total healthcare expenditures ($18.91) vs nonadherence.
Within one year, statin adherence was associated with more outpatient and fewer inpatient visits, lower outpatient and inpatient expenditures, and lower total expenditures than nonadherence, within a commercially-insured population.
他汀类药物的依从性并不理想；然而，在美国商业保险人群中，尚未评估他汀类药物依从性（定义为药物依从性质量测量中的他汀类药物依从性）与一年内医疗保健服务使用和支出之间的关系。
调查 Pharmacy Quality Alliance（PQA）他汀类药物依从性质量测量中规定的他汀类药物依从性与商业健康计划一年内医疗资源利用和支出之间的关系。
这是一项为期一年的回顾性分析，涉及 Truven Health MarketScan 商业索赔和就诊研究数据库（2009-2015 年）中的个体队列。使用对数链接和负二项分布（使用）或伽马分布（支出）的广义线性模型，调整协变量后，评估药物依从性（≥80%的天数覆盖）与医疗保健使用和支出（调整为 2015 年美元）之间的关系。β系数用于计算成本比（CR）和费率比（RR）。预先设定了 0.001 的 α 水平。
在 4450308 名合格个体中，2757288 名（61.9%）被归类为依从者。多变量分析表明，依从者有更多的门诊（RR=1.009，95%CI=1.007，1.010）和更少的住院就诊（RR=0.756，95%CI=0.749，0.762）；以及较低的门诊（CR=0.965，95%CI=0.963，0.967）、住院（CR=0.780，95%CI=0.779，0.782）和总支出（CR=0.975，95%CI=0.973，0.977）。与不依从相比，依从性与每位成员每月的总医疗保健支出（$18.91）较低有关。
在一年内，与不依从相比，商业保险人群中，他汀类药物依从性与更多的门诊就诊和更少的住院就诊、较低的门诊和住院支出以及较低的总支出相关。
