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

被引:51
作者
Boye, Kristina Secnik [1 ]
Curtis, Sarah E. [1 ]
Lage, Maureen J. [2 ]
Garcia-Perez, Luis-Emilio [3 ]
机构
[1] Eli Lilly & Co, Lilly Corp Ctr, Global Patient Outcomes & Real World Evidence, Indianapolis, IN 46285 USA
[2] HealthMetr Outcomes Res LLC, Bonita Springs, FL USA
[3] Eli Lilly & Co, Lilly Corp Ctr, Global Med Affairs, Lilly Diabet, Indianapolis, IN 46285 USA
关键词
proportion of days covered; complications; costs; resource utilization; retrospective study; HEALTH-CARE COSTS; ECONOMIC OUTCOMES; CLAIMS DATA; ADULTS; IMPACT; MORTALITY; MELLITUS; HOSPITALIZATION; HYPOGLYCEMIA; MEDICATIONS;
D O I
10.2147/PPA.S107543
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: To 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 methods: The 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. Results: In 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). Conclusion: Higher 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.
引用
收藏
页码:1573 / 1581
页数:9
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