...
  • 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>Diabetes care >Decreased Antihyperglycemic Drug Use Driven by High Out-of-Pocket Costs Despite Medicare Coverage Gap Closure
【24h】

Decreased Antihyperglycemic Drug Use Driven by High Out-of-Pocket Costs Despite Medicare Coverage Gap Closure

机译：尽管有Medicare覆盖范围闭合，但仍减少由高口袋费用驱动的抗血糖药物使用

获取原文
获取原文并翻译 | 示例
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

OBJECTIVE Using the 2016 Medicare Part D coverage gap as an example, we explored effects of increased out-of-pocket costs on adherence to branded dipeptidyl peptidase 4 inhibitors (DPP-4i) in patients without financial subsidies relative to subsidized patients who do not experience increased spending during the gap. We also explored seasonality of reinitiation, because discontinuers may be more likely to reinitiate in January when benefits reset. RESEARCH DESIGN AND METHODS We identified DPP-4i or sulfonylurea initiators, aged >= 66 years, from a 20% sample of 2015-2016 Medicare claims. Difference-in-differences Poisson regression was used to compare adherence before and after entering the coverage gap between nonsubsidized and subsidized patients. Among discontinuers, monthly hazard ratios (HRs) for reinitiation relative to January 2016 were derived with Cox models. As a second control, we repeated analyses using sulfonylureas, generic low-cost alternatives. RESULTS In 2016, 8,096 subsidized and 6,173 nonsubsidized DPP-4i initiators entered the coverage gap. For nonsubsidized patients, copayment in the coverage gap was 45% ($227 per DPP-4i prescription), and adherence decreased from 68.4% to 49.0% after gap entry. Accounting for adherence differences in subsidized patients, nonsubsidized patients demonstrated reduced adherence to DPP-4i (difference-in-difference: -16.9%; 95% CI -18.7%, -15.1%) but not sulfonylureas (-1.6%; 95% CI -3.4%, 0.2%). Reinitiation was lowest in the months before January (HR 0.4-0.5) among nonsubsidized DPP-4i patients, demonstrating a strong seasonal pattern. CONCLUSIONS Increased out-of-pocket costs negatively affect adherence and reinitiation of branded antihyperglycemic drugs among patients without financial subsidies. Despite closure of the coverage gap, affordability remains a concern given increasing list prices for many drugs on Medicare and the growing use of deductibles and coinsurance by commercial health plans.
机译：目的使用2016 Medicare Part D覆盖范围的差距作为一个例子，我们探讨了在没有财务补贴的患者中依赖于品牌二肽肽肽酶4抑制剂（DPP-4i）的申请，而没有财政补贴，相对于不经历的补贴患者在差距期间增加支出。我们还探讨了加固的季节性，因为在福利重置时，中断人员可能更有可能重新加油。研究设计和方法我们鉴定了DPP-4I或磺脲类引发剂，年龄> = 66岁，来自2015-2016 Medicar索赔的20％样本。差异差异泊松回归用于比较非资金化和补贴患者之间的覆盖范围之前和之后的依从性。在停止者中，与2016年1月的再次加固每月危险比率（HRS）均衍生出COX模型。作为第二种控制，我们使用磺脲类，通用低成本替代品反复分析。结果2016年，8,096款补贴和6,173个不合理的DPP-4I启动人进入了覆盖范围。对于非保证的患者，覆盖范围的复制率为45％（每次DPP-4i处方227美元），差距入口后的68.4％至49.0％降低。核算补贴患者的依从性差异，非金属化患者证明了对DPP-4I的粘附减少（差异差异：-16.9％; 95％CI -18.7％，-15.1％）但不是磺酰脲（-1.6％; 95％CI -3.4％，0.2％）。在非资金化DPP-4I患者中，1月份（HR 0.4-0.5）前几个月重新增压，展示了强大的季节性模式。结论增加了口袋费用对患者的粘附性和加固，没有财政补贴。尽管缩短了覆盖范围差距，但可负担性仍然是一个令人担忧的担忧，因为增加了Medicare的许多药物和商业卫生计划越来越多的消防员和共同保险。

著录项

  • 来源
    《Diabetes care》 |2020年第9期|共7页
  • 作者

    Gokhale Mugdha; Dusetzina Stacie B.; Pate Virginia; Chun Danielle S.; Buse John B.; Sturmer Til; Gower Emily W.;

  • 作者单位

    GlaxoSmithKline Real World Evidence &

    Epidemiol Collegeville PA 19426 USA;

    Vanderbilt Univ Sch Med Dept Hlth Policy Nashville TN 37212 USA;

    Univ N Carolina Dept Epidemiol Gillings Sch Publ Hlth Chapel Hill NC 27515 USA;

    Univ N Carolina Dept Epidemiol Gillings Sch Publ Hlth Chapel Hill NC 27515 USA;

    Univ N Carolina Sch Med Dept Med Chapel Hill NC 27515 USA;

    Univ N Carolina Dept Epidemiol Gillings Sch Publ Hlth Chapel Hill NC 27515 USA;

    Univ N Carolina Dept Epidemiol Gillings Sch Publ Hlth Chapel Hill NC 27515 USA;

  • 收录信息
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 内分泌腺疾病及代谢病;
  • 关键词

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号