Clinical Outcomes and Incremental Costs From a Medication Adherence Pilot Intervention Targeting Low-Income Patients With Diabetes at Risk of Cost-Related Medication Nonadherence

• Published in: Clinical therapeutics 2014-12, Vol.36 (12), p.1991-2002
• Main Authors: Ryan, John G., DrPH, Fedders, Mark, MS, Jennings, Terri, PhD, Vittoria, Isabel, LMHC, Yanes, Melissa, MSW
• Format: Article
• Language: English
• Subjects: Adult; African American; Aged; Biological and medical sciences; Cholesterol; Chronic illnesses; Comorbidity; Cost estimates; Cost Savings; cost-related medication nonadherence; Cross-Sectional Studies; Diabetes; Diabetes Mellitus - drug therapy; Diabetes Mellitus - economics; Diabetes. Impaired glucose tolerance; Drug therapy; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Ethnicity; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Glycated Hemoglobin A - analysis; healthcare outcomes; Hispanic Americans; Hospital Costs; Hospitals; Humans; Hypoglycemic Agents - economics; Hypoglycemic Agents - therapeutic use; Internal Medicine; Low income groups; Male; Medical Education; Medical sciences; Medication Adherence; Middle Aged; minority health; Patients; Pharmacology. Drug treatments; Pharmacy; Pilot Projects; Poverty; Prescriptions; Social workers; type 2 diabetes; Uninsured people
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2014.09.001

Abstract Purpose The extent to which reducing cost-related barriers affects diabetes outcomes and medication adherence among uninsured patients is not known. The purpose of these analyses was to understand the clinical impact and cost considerations of a prescription assistance program targeting low-income, minority patients with diabetes and at high risk for cost-related medication nonadherence. Methods Patients received diabetes medications without copayments for 12 months. Change in diabetes control was calculated by using glycosylated hemoglobin (HbA1c ) level at follow-up compared with baseline. Clinical data were collected from the electronic health record. Medication adherence for diabetes medications was estimated by using proportion of days covered (PDC). Incremental acquisition and per-patient costs, based on actual hospital medication costs, were calculated for different baseline HbA1c levels. Findings Patients with baseline HbA1c levels ≥7%, ≥8%, and ≥9% experienced mean HbA1c reductions of 0.82% ( P = 0.008), 1.02% ( P = 0.010), and 1.47% ( P = 0.010), respectively, during the 12-month period. The average PDC was 70.55%; 45.24% had a PDC ≥80%, indicating an adequate level of medication adherence. Medication adherence ≥80% was associated with ethnicity ( P = 0.015), whereas mean PDC was associated with number of diabetes medication classes used ( P = 0.031). Acquisition cost for 1242 prescriptions filled by 103 patients was $13,365.82, representing per-patient costs of $132.39; however, as baseline targets increased, acquisition costs decreased and per-patient costs increased from $10,682.59 and $169.56 to $6509.91 and $192.27, respectively. Implications Clinically significant reductions in HbA1c levels were achieved for all patients, although greater reductions were achieved with modest per-patient cost increases when considering patients with uncontrolled diabetes. Incorporating a multifactorial intervention to address cost-related medication nonadherence with a behavior change component may yield greater reductions in HbA1c with improved diabetes outcomes and meaningful hospital-based cost savings.