Chen Brian, McDermott Suzanne, Salzberg Deborah, Zhang Wanfang, Hardin James W
Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC.
Department of Environmental, Occupational, and Geospatial Health Sciences, CUNY Graduate School of Public Health & Health Policy, New York, NY.
Med Care. 2025 Jan 1;63(1 Suppl 1):S15-S24. doi: 10.1097/MLR.0000000000001946. Epub 2024 Dec 6.
Adults with intellectual and developmental disabilities (IDDs) have a similar prevalence of hypertension as the general population, but a higher rate of medication nonadherence at 50% compared with the average of 30%.
To assess the cost-effectiveness of educational messaging and prescription-fill reminders to adults with IDD and hypertension and their helpers among Medicaid members in a randomized control trial.
The authors calculated net cost savings by subtracting per-participant intervention costs from differences in spending between preintervention/postintervention cases versus controls. Using bootstrap samples, they assessed the probability of positive cost savings. They used quantile and logistic regression to examine which members contributed to the cost savings and to identify future high-cost members at baseline.
Four hundred twelve members with IDD and their helpers were recruited from the South Carolina Medicaid agency in 2018.
Intervention costs were determined using labor and communication costs. Health expenditures were obtained from South Carolina's all-payer claims database, using actual Medicaid expenditures and total all-payer expenditures estimated with cost-to-charge ratios.
The intervention, which cost $26.10 per member, saved $1008.02 in all-payer spending and $1126.42 in Medicaid payments per member, respectively, with 78% and 91% confidence. Cost savings occurred among members above the 85th percentile of spending, and those using the emergency department or inpatient services at least twice at baseline were predicted to be future high-cost members.
The intervention is cost-saving, and insurers can prospectively identify and target members who will likely benefit.
患有智力和发育障碍（IDD）的成年人高血压患病率与普通人群相似，但药物治疗不依从率为50%，高于平均30%的水平。
在一项随机对照试验中，评估教育信息和处方填充提醒对医疗补助计划成员中患有IDD和高血压的成年人及其帮助者的成本效益。
作者通过从干预前/干预后病例与对照组的支出差异中减去每位参与者的干预成本来计算净成本节约。使用自助抽样，他们评估了成本节约为正的概率。他们使用分位数回归和逻辑回归来研究哪些成员促成了成本节约，并在基线时识别未来的高成本成员。
2018年从南卡罗来纳州医疗补助机构招募了412名患有IDD的成员及其帮助者。
使用劳动力和通信成本确定干预成本。健康支出从南卡罗来纳州的全支付者索赔数据库中获取，使用实际医疗补助支出和根据成本收费比率估计的全支付者总支出。
该干预措施每位成员成本为26.10美元，分别在全支付者支出中节省了1008.02美元，在医疗补助支付中每位成员节省了1126.42美元，置信度分别为78%和91%。支出高于第85百分位数的成员实现了成本节约，预计那些在基线时至少两次使用急诊科或住院服务的成员将成为未来的高成本成员。
该干预措施具有成本节约效果，保险公司可以前瞻性地识别并针对可能受益的成员。
