医学
药店
成本分摊
2型糖尿病
药方
糖尿病
急诊医学
总成本
医疗保健
回顾性队列研究
管理式护理
内科学
家庭医学
护理部
经济增长
微观经济学
经济
内分泌学
作者
Thornton Snider J,Seth A. Seabury,Janice Lopez,S. McKenzie,Goldman Dp
出处
期刊:PubMed
日期:2016-06-01
卷期号:22 (6): 433-40
被引量:25
摘要
To study the association between cost sharing for diabetes medications, adherence, hospitalization rates, and healthcare costs, with relationship to patient risk.A retrospective claims analysis of data from 35 large, private, self-insured employers (2004 to 2012).We examined outcomes for 92,410 patients aged 18 to 64 years with a type 2 diabetes (T2D) diagnosis who filled at least 1 T2D prescription. First, we examined the relationship between adherence, measured as the proportion of days covered, and cost sharing, measured as the out-of-pocket cost to purchase a pre-specified bundle of T2D prescriptions. We then examined the association between adherence and hospital days. Simulations showed the effect of increased cost sharing on adherence and inpatient utilization.A $10 increase in out-of-pocket cost was associated with a 1.9% reduction in adherence (P < .01). In turn, a 10% reduction in adherence was associated with a 15% increase in per-patient hospital days (0.17 days; P < .01). For the average plan, switching from low to high cost sharing reduced per-patient medication costs by $242 and increased per-patient hospitalization costs by $342, for a net increase of $100 in plan costs. Increases in per-patient costs were greater for high-risk patients, such as those with heart failure ($1328).Increased cost sharing for T2D medication was associated with reductions in pharmacy costs, but higher total costs for patients with T2D. This problem is particularly acute for patients with 1 or more cardiovascular comorbidities. The results suggest that increased diabetes cost sharing may hamper efforts to lower the total cost of diabetes care.
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