Predictors of medication adherence and associated health care costs in an older population with type 2 diabetes mellitus: A longitudinal cohort study

Balkrishnan, Rajesh; Rajagopalan, Rukmini; Camacho, Fabian; Huston, Sally A.; Murray, Frederick T.; Anderson, Roger T.

doi:10.1016/s0149-2918(03)80347-8

Cited by 290 publications

(218 citation statements)

References 19 publications

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“…[40][41][42][43][44][45] Diabetes is increasingly common among seniors, with prevalence rates estimated at 26.7 % and 390,000 cases diagnosed annually. 46 Generic medications are used as first-line and second-line therapies, with Metformin, a Biguanide, and Sulfonylureas (Glimepiride, Glipizide, Glyburide) available as inexpensive $4 cash generics.…”

Section: Introductionmentioning

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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Section: Introductionmentioning

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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“…1,2 Harm caused by nonadherence to appropriately prescribed medicines is significant. [3][4][5][6][7] Cost of illness in the US caused by nonadherence is estimated at $100 billion per annum, 8 referred to as the nation's "other drug problem." 9 Medication adherence increases with higher income and reduced medication costs, is variably related to age, gender, marital status, ethnicity, education, social support and presence of depression or cognitive impairment, number of prescribing physicians, and use of multiple pharmacies.…”

Section: Introductionmentioning

confidence: 99%

Strategies for Coping in a Complex World: Adherence Behavior Among Older Adults with Chronic Illness

et al. 2007

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“…The few longitudinal studies in this area either have been small 7 or have not focused on changes in adherence. 8,9 The lack of strong evidence has doi: 10.1377/hlthaff.…”

mentioning

confidence: 99%

Greater Adherence To Diabetes Drugs Is Linked To Less Hospital Use And Could Save Nearly $5 Billion Annually

Jha

Aubert²,

Yao³

et al. 2012

Health Affairs

145

112

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Improving adherence to medication offers the possibility of both reducing costs and improving care for patients with chronic illness. We examined a national sample of diabetes patients from 2005 to 2008 and found that improved adherence to diabetes medications was associated with 13 percent lower odds of subsequent hospitalizations or emergency department visits. Similarly, losing adherence was associated with 15 percent higher odds of these outcomes. Based on these and other effects, we project that improved adherence to diabetes medication could avert 699,000 emergency department visits and 341,000 hospitalizations annually, for a saving of $4.7 billion. Eliminating the loss of adherence (which occurred in one out of every four patients in our sample) would lead to another $3.6 billion in savings, for a combined potential savings of $8.3 billion. These benefits were particularly pronounced among poor and minority patients. Our analysis suggests that improved adherence among patients with diabetes should be a key goal for the health care system and policy makers. Strategies might include reducing copayments for certain medications or providing feedback about adherence to patients and providers through electronic health records.

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Predictors of medication adherence and associated health care costs in an older population with type 2 diabetes mellitus: A longitudinal cohort study

Cited by 290 publications

References 19 publications

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

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

Strategies for Coping in a Complex World: Adherence Behavior Among Older Adults with Chronic Illness

Greater Adherence To Diabetes Drugs Is Linked To Less Hospital Use And Could Save Nearly $5 Billion Annually

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