Associations between adherence and outcomes among older, type 2 diabetes patients: evidence from a Medicare Supplemental database

Abstract

ObjectiveTo examine the association between adherence to glucose-lowering agents and patient outcomes, including costs, acute-care resource utilization, and complications, in an older, type 2 diabetic population.Data and methodsThe study used Truven’s Medicare Supplemental database from July 1, 2009 to June 30, 2014. Patients aged 65 years or older were included if they had at least two type 2 diabetes diagnoses and received a glucose-lowering agent from July 1, 2010 through June 30, 2011. Multivariable analyses examined the relationships among 3-year patient outcomes and levels of adherence, proxied by the proportion of days covered. Outcomes included all-cause medical costs, diabetes-related medical costs, acute-care resource utilization, and acute complications.ResultsIn this study (N=123,235), higher adherence was linked to reduced costs and improved health outcomes. For example, comparing an individual with adherence of proportion of days covered <20% to one with proportion of days covered ≥80% illustrates an average saving of $28,824 in total 3-year costs. Furthermore, a 1% increase in adherence among 1,000 patients was associated with all-cause savings of $65,464 over 3 years. The probability of a hospitalization, an emergency room (ER) visit, or an acute complication decreased monotonically as adherence levels got higher, as did the number of hospitalizations, ER visits, and days hospitalized (P<0.005).ConclusionHigher adherence was associated with substantially less need for acute care, as indicated by a lowered probability of hospitalization or ER use, a reduced risk of an acute complication, and a decreased number of hospitalizations, ER visits, and days hospitalized. Higher adherence was also generally associated with lower all-cause and diabetes-related total costs, despite higher drug costs. These lower total costs were driven by the diminished acute care and outpatient costs. Results suggest that higher glucose-lowering agent adherence is associated with significant benefits for payers and older patients with type 2 diabetes.

Medication adherence and glycemic control among newly diagnosed diabetes patients

“…[27][28][29] We extracted dispensed medication records from our disease registry and calculated PDC as a measure of adherence since it is the preferred method of measuring medication adherence. 30 The prevalence rate of medication non-adherence (PDC <80%) among the newly diagnosed diabetes patients was 35%, which was higher than that reported by Ho et al (21.3%) 27 but lower than that reported by Boye et al (36.9%) 28 and Huber et al (57.6%). 29 We found that there were ethnic differences in medication adherence.…”

“…29 Boye et al also provided evidence that the probability of a hospitalization and emergency room visit decreased monotonically as PDC increased. 28 Hong and Kang found that among newly diagnosed type 2 diabetes patients, patients with MPR <80% had a 1.26 times risk in hospitalization compared with patients with MPR ≥80%. 23 While adherence itself leads to better glycemic control and fewer ED visits and hospitalizations, patients who are adherent to their medications are also likely to adhere with behavioral modification, glucose self-monitoring, attendance with medical care, and other components of diabetes self-management.…”

Glucagon-like Peptide-1 Receptor Agonist Treatment Attributes Important to Injection-Naïve Patients with Type 2 Diabetes Mellitus: A Multinational Preference Study

“…If an appreciation and understanding of patients’ preference for treatment can be gained and a patient-centered approach is used during clinical decision-making, then adherence is likely to improve [7]. If adherence can be increased, then improvements in diabetes-related outcomes will be likely, including improvements in glycemic control, and reductions in short-term and long-term diabetes-related complications, and healthcare resource utilization [10, 12, 14, 34–37]. Medication regimens with less frequent dosing regimen are associated with greater adherence to medication [38].…”

Effect of Medication Copayment on Adherence and Discontinuation in Medicare Beneficiaries with Type 2 Diabetes: A Retrospective Administrative Claims Database Analysis

“…As the proportion of elderly individuals continues to grow, successful management of diabetes must include maintaining high levels of adherence to reduce the incidence and severity of diabetes-associated complications and healthcare costs. A retrospective analysis using a large Medicare claims database (Truven Medicare Supplemental database; data from 1 July 2009 to 30 June 2014) evaluated the association between adherence and outcomes in patients aged ≥ 65 years with T2D ( N = 123,235) [ 33 ]. Study results showed that higher AHA adherence rates were associated with a substantial decreases in total medical costs that were driven by reduced acute care costs despite higher drug costs.…”