University of Arizona College of Pharmacy, Tucson, and Eli Lilly and Company, Indianapolis, IN.
University of Arizona College of Pharmacy, Tucson.
J Manag Care Spec Pharm. 2021 Jan;27(1):64-72. doi: 10.18553/jmcp.2021.27.1.064.
Diabetes is a prevalent chronic condition in the United States that results in considerable morbidity and mortality, frequent use of the health care system, and high health care expenditures. Adherence to antidiabetic medications can help improve health outcomes and lower health care utilization and expenditures. The Pharmacy Quality Alliance (PQA) Proportion of Days Covered (PDC): Diabetes All Class medication adherence measure was developed and endorsed to improve adherence to noninsulin antidiabetic medications; however, it has not been assessed in a commercial population of diabetes patients over a 1-year time frame. To determine the association between adherence, as defined in the PQA medication adherence measures, and health care utilization and expenditure among commercially insured individuals using antidiabetic medications. This 1-year retrospective study evaluated a cohort of individuals from IBM MarketScan Research Databases (2009-2015) with noninsulin antidiabetic medications. Eligible study subjects included adults (aged ≥ 18 years at index date) with continuous enrollment in their health plans for 6 months before (i.e., baseline period) and 12 months after (i.e., study period) the index date and ≥ 2 prescriptions dispensed for any medication included in the PQA PDC Diabetes All Class medication adherence measure, with at least 150 days between the first and last fill during the study period. The index date was defined as the first fill for a medication included in the PQA PDC Diabetes All Class adherence measure after a 180-day baseline period. Generalized linear models with log link and gamma distribution (expenditure) or negative binomial distribution (utilization) assessed relationships between adherence (≥ 80% PDC) and health care utilization and expenditure while adjusting for potential confounders. Cost ratios (CR) and rate ratios (RR) were computed using beta coefficients. Cohort characteristics were compared using t-tests, Wilcoxon rank sum tests, or chi-square tests with an alpha level of 0.001 set a priori. A total of 1,576,112 individuals were eligible; of these, 1,028,176 (65.2%) were adherent. Significant differences in demographic characteristics were observed between adherent and nonadherent groups ( < 0.001). Multivariable analyses demonstrated that adherence was associated with the following: (a) 16.6% fewer inpatient (RR = 0.834, 95% CI = 0.819-0.850) and 3.6% more outpatient service visits (RR = 1.036, 95% CI = 1.032-1.039) and (b) 16.8% lower inpatient expenditures (CR = 0.833, 95% CI = 0.829-0.836); 2.6% lower outpatient expenditures (CR = 0.974, 95% CI = 0.970-0.978); 16.4% higher prescription drug expenditures (CR = 1.164, 95% CI = 1.159-1.169); and 4.2% lower total (CR = 0.958, 95% CI = 0.954-0.962) expenditures. Adherent subjects were associated with lower incremental per member per month expenditures for inpatient (-$31.74), outpatient (-$10.09), and total (-$30.82) expenditures, yet higher prescription drug expenditures ($25.60) compared with nonadherent subjects. Adherence to noninsulin antidiabetic medications was associated with more outpatient and fewer inpatient visits, as well as lower total expenditures compared with nonadherence. Funding was provided by grants from Pharmacy Quality Alliance, Merck & Co. (Kenilworth, NJ), and SinfoniaRx. In addition, Chinthammit reports personal fees from Eli Lilly and Company, outside the submitted work. Axon reports grants from the American Association of Colleges of Pharmacy and the Arizona Department of Health Services, outside the submitted work. Taylor reports grants from the Arizona Department of Health Services, outside the submitted work. Warholak reports grants from Novartis and the Arizona Department of Health Services, outside the submitted work. Chinthammit and Campbell disclose that this work was completed during their employment at the University of Arizona. This research was presented as a poster at the AMCP Annual Meeting 2019; March 25-28, 2019; San Diego, CA.
糖尿病是美国一种普遍的慢性疾病，会导致相当高的发病率和死亡率、频繁使用医疗保健系统以及高额的医疗保健支出。坚持使用抗糖尿病药物可以帮助改善健康结果并降低医疗保健的利用和支出。药房质量联盟（PQA）的比例天数覆盖（PDC）：糖尿病所有类别的药物依从性衡量标准是为了改善非胰岛素抗糖尿病药物的依从性而开发和认可的；然而，它尚未在商业人群的糖尿病患者中进行为期 1 年的评估。为了确定在使用抗糖尿病药物的商业保险个体中，根据 PQA 药物依从性衡量标准定义的依从性与医疗保健利用和支出之间的关联。这项为期 1 年的回顾性研究评估了 IBM MarketScan 研究数据库（2009-2015 年）中的一个队列，该队列包括在指数日期前 6 个月连续参加其健康计划的成年人（年龄≥18 岁），以及在指数日期后 12 个月内（即研究期间）至少有 2 份用于任何包含在 PQA PDC 糖尿病所有类别的药物依从性衡量标准中的药物的处方，并且在研究期间的第一次和最后一次配药之间至少有 150 天。指数日期被定义为在 180 天基线期后首次使用 PQA PDC 糖尿病所有类别的药物依从性衡量标准的药物。使用对数链接和伽马分布（支出）或负二项式分布（利用）的广义线性模型调整潜在混杂因素后，评估了依从性（≥80%PDC）与医疗保健利用和支出之间的关系。使用贝塔系数计算成本比（CR）和速率比（RR）。使用 t 检验、Wilcoxon 秩和检验或卡方检验（预先设定 alpha 水平为 0.001）比较队列特征。共有 1576112 人符合条件；其中 1028176 人（65.2%）依从。在依从性和不依从性组之间观察到人口统计学特征存在显著差异（<0.001）。多变量分析表明，依从性与以下因素相关：（a）住院治疗减少 16.6%（RR=0.834，95%CI=0.819-0.850）和门诊服务就诊增加 3.6%（RR=1.036，95%CI=1.032-1.039），（b）住院治疗支出减少 16.8%（CR=0.833，95%CI=0.829-0.836）；门诊支出减少 2.6%（CR=0.974，95%CI=0.970-0.978）；处方药支出增加 16.4%（CR=1.164，95%CI=1.159-1.169）；总支出增加 4.2%（CR=0.958，95%CI=0.954-0.962）。与不依从的受试者相比，依从的受试者的每个成员每月的住院（-31.74 美元）、门诊（-10.09 美元）和总（-30.82 美元）支出的增量更低，而处方药支出更高（25.60 美元）。与不依从相比，使用非胰岛素抗糖尿病药物的依从性与更多的门诊和更少的住院就诊以及更低的总支出相关。资金由 Pharmacy Quality Alliance、Merck & Co.（Kenilworth，NJ）和 SinfoniaRx 提供。此外，Chinthammit 报告了来自 Eli Lilly and Company 的个人费用，这与提交的工作无关。Axon 报告了来自美国药学院协会和亚利桑那州卫生服务部的拨款，这与提交的工作无关。Taylor 报告了来自亚利桑那州卫生服务部的拨款，这与提交的工作无关。Warholak 报告了来自诺华公司和亚利桑那州卫生服务部的拨款，这与提交的工作无关。Chinthammit 和 Campbell 披露，这项工作是在他们任职于亚利桑那大学期间完成的。这项研究作为海报在 2019 年 AMCP 年会上展示；2019 年 3 月 25-28 日；圣地亚哥，CA。
