Predicting Costs of Care Using a Pharmacy-Based Measure Risk Adjustment in a Veteran Population

Sales, Anne E.; Liu, Chuan‐Fen; Sloan, Kevin L.; Malkin, Jesse D.; Fishman, Paul; Rosen, Amy K.; Loveland, Susan; Nichol, W. Paul; Suzuki, Norman T.; Perrin, Edward B.; Sharp, Nancy; Todd-Stenberg, Jeffrey

doi:10.1097/01.mlr.0000069502.75914.dd

Cited by 71 publications

(58 citation statements)

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“…This specification is nonparametric in the sense that the parameters of the expectation conditional on age and sex are of free variation. In this paper we also consider two other specifications: a "parametric" specification in which the sex and age of each individual enter as independent variables 7 in a nonlinear specification (sex, age, age 2 , age 3 , age 4 ); and a more flexible parametric specification which, for convenience, can be termed as "flexible-parametric", in which interactions between age and sex are explored in a nonlinear way (age, age 2 , age 3 , age 4 , sex*age, sex*age 2 , sex*age 3 , sex*age 4 ). Our dependent variable, drug expenditures, is a censored variable ( 0 ≥ itures DrugExpend ) with a large number of zeros (39.65%).…”

Section: Estimation Methodsmentioning

confidence: 99%

“…Although several studies have used pharmacy data to predict total health care costs [4,5,6,7,8,9], only a few have addressed the issue of predictability of drug spending. A feasible explanation is that usually private insurers do not offer free standing drug benefits, and public programs offering those benefits have not developed private riskbased contracts [10].…”

Section: Introductionmentioning

confidence: 99%

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Predictability of drug expenditures: an application using morbidity data

García-Goñi

Ibern

2007

Health Economics

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Section: Estimation Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictability of drug expenditures: an application using morbidity data

García-Goñi

Ibern

2007

Health Economics

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“…51 CDS is a well-validated, pharmacy-based riskadjustment tool that uses pharmacy fill data to identify patient risk in different patient populations. [52][53][54][55][56][57][58][59][60][61][62] We refer to this measure as the risk score.…”

Section: Study Design and Study Samplementioning

confidence: 99%

Cost Sharing and Decreased Branded Oral Anti-Diabetic Medication Adherence Among Elderly Part D Medicare Beneficiaries

et al. 2013

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BACKGROUND:Although the Medicare Part D coverage gap phase-out should reduce cost-related nonadherence (CRN) among seniors with diabetes, preferential generic prescribing may have already decreased CRN, while smaller numbers of patients using more costly branded oral antidiabetic (OAD) medications remain vulnerable to CRN. OBJECTIVE: To estimate the effects of cost sharing in the Part D standard (non-LIS) benefit on adherence to different OAD classes, comparing two classes dominated by inexpensive generic medications and two by more costly branded medications. DESIGN AND PATIENTS: Retrospective cohort study using dispensed prescription data for elderly non-LIS (N= 81,047) and LIS (low-income subsidy) (N=150,359) beneficiaries using same class OAD(s) in 2008 and 2009. Logistic regression modeled non-LIS likelihood; LIS and non-LIS patients matched using propensity outcome (N= 38,054). Logistic regression, controlling for demographic and health status characteristics, modeled effects of non-LIS coverage on 2009 OAD class adherence. MAIN MEASURES: Main outcome measures were within-class OAD coverage year adherence, with patients considered adherent when days supplied to calendar days ratio at least 0.8. KEY RESULTS: Non-LIS patients had 0.52 and 0.57 times the odds of branded-only DPP-4 Inhibitor (N= 1,812; 95 % CI: 0.43, 0.63; P<0.001) and Thiazolidinedione (TZD) (N=6,290; 95 % CI: 0.52, 0.63; P<0.001) adherence. Most patients (N=32,510; 82 %) used OADs in primarily generic classes, where we found no significant (Biguanides; N=21,377) or small differences (Sulfonylureas/Glinides [N=19,240; OR: 0.91; 95 % CI: 0.86, 0.97; P =0.002]) in adherence odds. Crude adherence rates were sub-optimal when CRN was not a factor (Non-LIS/LIS: Biguanides: 65 %/65 %; Sulfonylureas/Glinides: 66 %/ 68 %; LIS: DPP-4 Inhibitors: 66 %; TZDs: 67 %). CONCLUSIONS: Gap elimination would not affect generic, but should reduce branded OAD CRN. Branded copayments may continue to lead to CRN. Policy initiatives and benefit changes targeting both cost deterrents for patients with more complex disease and non-cost generic OAD underuse are recommended.

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“…[41][42] The Chronic Disease Score is a well-validated comorbidity tool that uses pharmacy fill data to identify patient risk in different patient groups. 17,[42][43][44][45] Our comorbidities included hypertension, hyperlipidemia, cardiovascular disease, and depression, which are conditions that often accompany diabetes. We …”

mentioning

confidence: 99%

The Effects of Cost Sharing on Adherence to Medications Prescribed for Concurrent Use: Do Definitions Matter?

Sacks¹,

Burgess²,

Cabral³

et al. 2015

JMCP

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BACKGROUND: Accurate estimates of the effects of cost sharing on adherence to medications prescribed for use together, also called concurrent adherence, are important for researchers, payers, and policymakers who want to reduce barriers to adherence for chronic condition patients prescribed multiple medications concurrently. But measure definition consensus is lacking, and the effects of different definitions on estimates of cost-related nonadherence are unevaluated.

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Predicting Costs of Care Using a Pharmacy-Based Measure Risk Adjustment in a Veteran Population

Cited by 71 publications

References 10 publications

Predictability of drug expenditures: an application using morbidity data

Predictability of drug expenditures: an application using morbidity data

Cost Sharing and Decreased Branded Oral Anti-Diabetic Medication Adherence Among Elderly Part D Medicare Beneficiaries

The Effects of Cost Sharing on Adherence to Medications Prescribed for Concurrent Use: Do Definitions Matter?

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