MEDICAL COST SAVINGS FROM MEDICATION ADHERENCE AND IMPLICATIONS FOR TARGETING BEHAVIORAL INTERVENTIONS

Purpose: Behavioral interventions to support patients in medication adherence must be well targeted if policy makers are to improve population health within budgets. We investigated the impact of comorbidity and changes in adherence behavior on medical spending.

Method: Patients had at least one of three conditions---diabetes, hypertension hypercholesterolemia – in a national data set of 10 million commercial beneficiaries (Optum; Minneapolis, MN). Baseline was April 2011 – March 2012; Follow-up was April 2012 – March 2013. Outcome was spending on medical services (i.e., inpatient and outpatient; pharmacy was not included). We assembled two cohorts: 1) members adherent (MPR≥0.80); and 2) members not adherent (MPR<0.80) at baseline. Spending on patients who were persistent in adherence at baseline and follow-up (reference) were compared with those who became non-adherent at follow-up. Members who newly achieved adherence at follow-up were compared with those who were non-adherent at baseline and follow-up (reference).Medical spending during the follow-up was estimated using generalized linear modeling methods adjusting for baseline medical spending, preventive service use, age, gender, Charlson Index, initiator/continuer status, and census region. Stratified analyses were conducted based upon comorbidity (Charlson score ≥3) versus low (<3).

Result: See table (negative number indicates a decrease in spending on medical services baseline to follow-up). Patients with diabetes experienced a similar magnitude of change in spending regardless of whether they became non-persistent or achieved adherence. In patients with hypertension and hypercholesterolemia, those who lost persistence had a larger change in spending than non-adherent patients who became adherent. In stratified analyses, the largest changes were seen in patients with a Charlson score of 3+ in the baseline year. Among these patients, there was at least a $2,000 change in spending when adherence status changed.

Conclusion: The association between adherence behavior and medical spending differs significantly between persistent patients or achieve adherence and across levels of comorbidity. Understanding these differences is important when implementing programs to help patients with medication adherence and can assist providers and payers in prioritizing intervention efforts

 

	All Patients		Charlson 3+		Charlson ≤ 2
	Persistent to Non-adherent	Non- Adherent  to Adherent	Persistent to Non-adherent	Non-adherent to Adherent	Persistent to Non-adherent	Non-adherent to Adherent
Diabetes	$2,763	-$2,495	$4,653	-$5,341	$1,654	-$757
Hypertension	$2,663	-$766	$7,946	-$4,423	$1,706	-$124
Hypercholesterolemia	$1,526	-$26	$4,008	-$2,081	$1,045	$365