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General interest items edited by Janice Flahiff

[Repost] Medical Cost Offsets from Prescription Drug Utilization Among Medicare Beneficiaries

Medical Cost Offsets from Prescription Drug Utilization Among Medicare Beneficiaries

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Excerpt from the commentary by M. Christopher Roebuck, PhD, MBA

SUMMARY
This brief commentary extends earlier work on the value of adherence to derive medical cost offset estimates from prescription drug utilization. Among seniors with chronic vascular disease, 1% increases in condition-specific medication use were associated with significant (P<0.001) reductions in gross nonpharmacy medical costs in the amounts of 0.63% fordyslipidemia, 0.77% for congestive heart failure, 0.83% for diabetes, and1.17% for hypertension.
J Manag Care Pharm.
2014;20(10):994-95
Excerpts:
With about half of patients not taking their medications as directed, avoidable adverse health events and use of medical services are estimated to add up to $290 billion in U.S.health care expenditures annually. Improvements in clinical and economic outcomes from medication adherence have been demonstrated across a variety of conditions and patientcohorts. As an example, in 2011 my colleagues and I (Roebuck et al.) determined that adherence to medication for chronic vascular disease was associated with fewer inpatient hospital days and emergency department visits and lower overal health care costs. Specifically, annual net savings in healtcare expenditures for an adherent (compared to nonadherent) elderly beneficiary were estimated to be $7,893 for congestive
heart failure, $5,824 for hypertension, $5,170 for diabetes, and $1,847 for dyslipidemia—or approximately 9% to 28% of total
health care costs. This research employed a rigorous observational study design that addressed a key concern and limitation
ofprior analyses—the potentialendogeneity (confounding) of adherence. More plainly, results reported in earlier publications mayhave been biased if patients who took medications as directed also engaged in other unmeasured healthy behaviors

(i.e., the “healthy adherer effect”)
..
Figure 1 presents the new findings and includes the CBO estimate for reference. Specifically, 1% increases in condition-specific prescription drug utilization were significantly (P<0.001) associated with reductions in seniors’ gross nonpharmacy medical costs in the amounts of 0.63% for dyslipidemia, 0.77% for congestive heart failure, 0.83% for diabetes, and 1.17% for hypertension. These results demonstrate that medical cost offsets from prescription drug utilization likely vary bychronic condition and that impacts for therapeutic classes used to treat these 4 conditions—which represent 40% of Medicare Part D utilization—may be between 3 and 6 times greater than the CBO’s assumption. In dollar terms, these relative impacts are not trivial. For example, 53% of Medicare (fee-for-service) beneficiaries have the comorbidity combination of hyperten sion plus high cholesterol—with average annual medical costs of $13,825. The current findings suggest that a 5% increase in the use of antihypertensive medication by patients with those conditions may prompt reductions in medical (Parts A and B) costs of more than $800 annually per beneficiary.
….
The present analysis examined retirees with employer-sponsored insurance in addition to Medicare. To the extent that these individuals differed from the broader Medicare population, the generalizability of study findings may be limited.
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November 3, 2014 - Posted by | health care | , , , , , , ,

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