Tsang Chi Chun Steve, Wang Junling, Shih Ya-Chen Tina
Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN.
University of California, Los Angeles, School of Medicine, Los Angeles, CA.
Medicine (Baltimore). 2024 May 3;103(18):e37935. doi: 10.1097/MD.0000000000037935.
Inappropriate medication utilization among older adults is a pressing concern in the United States, owing to its high prevalence and the consequential detrimental impact it engenders. The adverse effects stemming from the inappropriate use of medication may be unequally borne by racial/ethnic minority populations, calling for greater efforts towards promoting equity in healthcare. The study objective was to assess the cost-effectiveness of Medication Therapy Management (MTM) services among Medicare beneficiaries and across racial/ethnic groups.
Medicare administrative data from 2016 to 2017 linked to Area Health Resources Files were used to analyze Medicare fee-for-service patients aged 65 or above with continuous Parts A/B/D coverage. The intervention group included new MTM enrollees in 2017; the control group referred to patients who met the general MTM eligible criteria but did not enroll in 2016 or 2017. The 2 groups were matched using a propensity score method. Effectiveness was evaluated as the proportion of appropriate medication utilization based on performance measures developed by the Pharmacy Quality Alliance. Costs were computed as total healthcare costs from Medicare perspective. A multivariable net benefit regressions with a classic linear model and Bayesian analysis were utilized. Net benefit was calculated based on willingness-to-pay thresholds at various multiples of the gross domestic product in 2017. Three-way interaction terms among dummy variables for MTM enrollment, 2017, and racial/ethnic minority groups were incorporated in a difference-in-differences study design.
After adjusting for patient characteristics, the findings indicate that MTM receipt was associated with incremental net benefit among each race and ethnicity. For instance, the net benefit of MTM among the non-Hispanic White patients was $2498 (95% confidence interval = $1609, $3386) at a willingness-to-pay value of $59,908. The study found no significant difference in net benefits for MTM services between minority and White patients.
The study provides evidence that MTM is a cost-effective tool for managing medication utilization among the Medicare population. However, MTM may not be cost-effective in reducing racial/ethnic disparities in medication utilization in the short term. Further research is needed to understand the long-term cost-effectiveness of MTM on racial/ethnic disparities.
在美国，老年人用药不当是一个紧迫的问题，因为其发生率高且会产生相应的有害影响。不当用药产生的不良影响可能在种族/族裔少数群体中分布不均，这就需要在促进医疗保健公平方面做出更大努力。本研究的目的是评估医疗保险受益人群以及不同种族/族裔群体中药物治疗管理（MTM）服务的成本效益。
利用2016年至2017年与地区卫生资源档案相关联的医疗保险行政数据，对年龄在65岁及以上、连续享有A/B/D部分保险的医疗保险按服务收费患者进行分析。干预组包括2017年新加入MTM的参保者；对照组指符合MTM一般合格标准但在2016年或2017年未参保的患者。两组采用倾向得分法进行匹配。有效性根据药房质量联盟制定的绩效指标，以适当用药的比例来评估。成本从医疗保险的角度计算为总医疗成本。采用经典线性模型和贝叶斯分析的多变量净效益回归方法。净效益根据2017年国内生产总值不同倍数的支付意愿阈值计算得出。在差异研究设计中纳入了MTM参保、2017年以及种族/族裔少数群体的虚拟变量之间的三向交互项。
在对患者特征进行调整后，研究结果表明，接受MTM与每个种族和族裔群体的增量净效益相关。例如，在支付意愿值为59,908美元时，非西班牙裔白人患者接受MTM的净效益为2498美元（95%置信区间 = 1609美元，3386美元）。研究发现，少数群体患者和白人患者接受MTM服务的净效益没有显著差异。
该研究提供了证据表明MTM是管理医疗保险人群用药的一种具有成本效益的工具。然而，MTM在短期内可能无法有效降低用药方面的种族/族裔差异。需要进一步研究以了解MTM对种族/族裔差异的长期成本效益。
