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Associations between adherence and outcomes among older, type 2 diabetes patients: evidence from a Medicare Supplemental database
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,...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Dove Medical Press
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4993402/ https://www.ncbi.nlm.nih.gov/pubmed/27574406 http://dx.doi.org/10.2147/PPA.S107543 |
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author | Boye, Kristina Secnik Curtis, Sarah E Lage, Maureen J Garcia-Perez, Luis-Emilio |
author_facet | Boye, Kristina Secnik Curtis, Sarah E Lage, Maureen J Garcia-Perez, Luis-Emilio |
author_sort | Boye, Kristina Secnik |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-4993402 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Dove Medical Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-49934022016-08-29 Associations between adherence and outcomes among older, type 2 diabetes patients: evidence from a Medicare Supplemental database Boye, Kristina Secnik Curtis, Sarah E Lage, Maureen J Garcia-Perez, Luis-Emilio Patient Prefer Adherence Original Research 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. Dove Medical Press 2016-08-16 /pmc/articles/PMC4993402/ /pubmed/27574406 http://dx.doi.org/10.2147/PPA.S107543 Text en © 2016 Boye et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. |
spellingShingle | Original Research Boye, Kristina Secnik Curtis, Sarah E Lage, Maureen J Garcia-Perez, Luis-Emilio Associations between adherence and outcomes among older, type 2 diabetes patients: evidence from a Medicare Supplemental database |
title | Associations between adherence and outcomes among older, type 2 diabetes patients: evidence from a Medicare Supplemental database |
title_full | Associations between adherence and outcomes among older, type 2 diabetes patients: evidence from a Medicare Supplemental database |
title_fullStr | Associations between adherence and outcomes among older, type 2 diabetes patients: evidence from a Medicare Supplemental database |
title_full_unstemmed | Associations between adherence and outcomes among older, type 2 diabetes patients: evidence from a Medicare Supplemental database |
title_short | Associations between adherence and outcomes among older, type 2 diabetes patients: evidence from a Medicare Supplemental database |
title_sort | associations between adherence and outcomes among older, type 2 diabetes patients: evidence from a medicare supplemental database |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4993402/ https://www.ncbi.nlm.nih.gov/pubmed/27574406 http://dx.doi.org/10.2147/PPA.S107543 |
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