Medication nonadherence in diabetes: longitudinal effects on costs and potential cost savings from improvement. Diabetes Care 2012 Dec;35(12):2533-9
Date
08/23/2012Pubmed ID
22912429Pubmed Central ID
PMC3507586DOI
10.2337/dc12-0572Scopus ID
2-s2.0-84869833581 (requires institutional sign-in at Scopus site) 156 CitationsAbstract
OBJECTIVE: To examine the longitudinal effects of medication nonadherence (MNA) on key costs and estimate potential savings from increased adherence using a novel methodology that accounts for shared correlation among cost categories.
RESEARCH DESIGN AND METHODS: Veterans with type 2 diabetes (740,195) were followed from January 2002 until death, loss to follow-up, or December 2006. A novel multivariate, generalized, linear, mixed modeling approach was used to assess the differential effect of MNA, defined as medication possession ratio (MPR) ≥0.8 on healthcare costs. A sensitivity analysis was performed to assess potential cost savings at different MNA levels using the Consumer Price Index to adjust estimates to 2012 dollar value.
RESULTS: Mean MPR for the full sample over 5 years was 0.78, with a mean of 0.93 for the adherent group and 0.58 for the MNA group. In fully adjusted models, all annual cost categories increased ∼3% per year (P = 0.001) during the 5-year study time period. MNA was associated with a 37% lower pharmacy cost, 7% lower outpatient cost, and 41% higher inpatient cost. Based on sensitivity analyses, improving adherence in the MNA group would result in annual estimated cost savings ranging from ∼$661 million (MPR <0.6 vs. ≥0.6) to ∼$1.16 billion (MPR <1 vs. 1). Maximal incremental annual savings would occur by raising MPR from <0.8 to ≥0.8 ($204,530,778) among MNA subjects.
CONCLUSIONS: Aggressive strategies and policies are needed to achieve optimal medication adherence in diabetes. Such approaches may further the so-called "triple aim" of achieving better health, better quality care, and lower cost.
Author List
Egede LE, Gebregziabher M, Dismuke CE, Lynch CP, Axon RN, Zhao Y, Mauldin PDMESH terms used to index this publication - Major topics in bold
Cost SavingsDiabetes Mellitus, Type 2
Humans
Hypoglycemic Agents
Models, Statistical
