Differences in Health Services Utilization and Costs between Antihypertensive Medication Users Versus Nonusers in Adults with Diabetes and Concomitant Hypertension from Medical Expenditure Panel Survey Pooled Years 2006 to 2009

• Published in: Value in health 2014, Vol.17 (1), p.51-61
• Main Authors: Davis-Ajami, Mary Lynn, PhD, MBA, MS, NP-C, RN, Wu, Jun, PhD, Fink, Jeffrey C., MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Antihypertensive Agents - economics; Antihypertensive Agents - therapeutic use; antihypertensive medication; Biological and medical sciences; blood pressure; costs; Cross-Sectional Studies; Diabetes; Diabetes Mellitus - economics; Expenditure; Female; General aspects; Health costs; Health Expenditures - statistics & numerical data; Health Services - economics; Health Services - utilization; Hospitalization; Humans; Hypertension; Hypertension - drug therapy; Hypertension - economics; Internal Medicine; Longitudinal Studies; Male; Medical sciences; Middle Aged; Miscellaneous; Pharmacology; Planification. Prevention (methods). Intervention. Evaluation; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; United States; utilization
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2013.11.008

Abstract Objectives To compare population-level baseline characteristics, individual-level utilization, and costs between antihypertensive medication users versus nonusers in adults with diabetes and concomitant hypertension. Methods This longitudinal retrospective observational research used Medical Expenditure Panel Survey household component pooled years 2006 to 2009 to analyze adults 18 years or older with nongestational diabetes and coexistent essential hypertension. Two groups were created: 1) antihypertensive medication users and 2) no antihypertensive pharmacotherapy. We examined average annualized health care costs and emergency department and hospital utilization. Accounting for Medical Expenditure Panel Survey’s complex survey design, all analyses used longitudinal weights. Logistic regressions examined the likelihood of utilization and anytihypertensive medication use, and log-transformed multiple linear regression models assessed costs and antihypertensive medication use. Results Of the 3261 adults identified with diabetes, 66% (n = 2137) had concomitant hypertension representing 38.7 million individuals during 2006 to 2009. Significantly, the 16% (n = 338) no antihypertensive pharmacotherapy group showed greater mean nights hospitalized (3.6 vs. 1.7, P = 0.0120), greater all-cause hospitalization events per 1000 patient months (41 vs. 24, P = 0.0.007), and lower mean diabetes-related and hypertension-related ambulatory visits. After adjusting for confounders, non-antihypertensive medication users showed 1.64 odds of hospitalization, 29% lower total, and 27% lower average annualized medical expenses compared with antihypertensive medication users. Conclusions In adults with diabetes and coexistent hypertension, we observed significantly greater hospitalizations and lower costs for the non antihypertensive pharmacotherapy group versus those using antihypertensive medications. The short-term time horizon greater hospitalizations with lower expenses among non-antihypertensive medication users with diabetes and concomitant hypertension warrant further study.