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首页> 外文期刊>Diabetes care >Medication nonadherence in diabetes: Longitudinal effects on costs and potential cost savings from improvement
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Medication nonadherence in diabetes: Longitudinal effects on costs and potential cost savings from improvement

机译：糖尿病患者的药物不依从性：对费用的纵向影响以及改进后可能节省的费用

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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.
机译：目的-要研究药物不依从性（MNA）对关键成本的纵向影响，并使用一种解释成本类别之间共享相关性的新颖方法，来评估依从性依从性增加带来的潜在节省。研究设计与方法-从2002年1月开始追踪2型糖尿病退伍军人（740,195），直到死亡，失访或2006年12月为止。采用了一种新颖的多元，广义，线性，混合建模方法来评估MNA，定义为医疗费用中的药物拥有率（MPR）≥0.8。使用消费者价格指数将估计值调整为2012年的美元价值，进行了敏感性分析，以评估不同MNA水平下的潜在成本节省。结果：5年内整个样本的平均MPR为0.78，依从组的平均值为0.93，MNA组的平均值为0.58。在完全调整的模型中，在5年的研究期内，所有年度成本类别每年均增加〜3％（P = 0.001）。 MNA的药房费用降低了37％，门诊费用降低了7％，住院费用提高了41％。根据敏感性分析，提高MNA组的依从性将导致每年估计的成本节省范围从约6.61亿（MPR <0.6 vs.≥0.6）到约11.6亿（MPR <1 vs. 1）。通过将MNA对象中的MPR从<0.8提高到≥0.8（204,530,778美元），可以最大程度地实现年度节省。结论需要积极的策略和政策来实现糖尿病患者最佳的药物依从性。这样的方法可以进一步实现所谓的“三重目标”，以实现更好的健康，更好的护理质量和更低的成本。

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