Adherence to Antipsychotic Therapy: Association With Hospitalization and Medicare Spending Among Part D Enrollees With Schizophrenia

Roberto, Pamela; Brandt, Nicole; Onukwugha, Eberechukwu; Perfetto, Elèanor M.; Powers, Christopher A.; Stuart, Bruce

doi:10.1176/appi.ps.201600434

Cited by 12 publications

(14 citation statements)

References 15 publications

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“…Twenty studies reported on analyses of administrative databases [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] of which 17 were US based [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] and 13 analysed Medicaid data [24][25][26][27][28][29][30][31][32][33][34][35][36]. A conference abstract provided additional cost data for one of the studies…”

Section: Analysis Of Administrative Databasesmentioning

confidence: 99%

“…The scope of these studies was generally limited to health care costs and some studies considered only hospital and pharmacy costs. Two studies contrasted the impact of adherence on mental and physical health care costs [26,40] and one study included criminal justice costs [27]. The complexity of these studies ranged from simple comparisons of costs across patient groups categorised by compliance to a sophisticated analysis of longer term costs which controlled for endogeneity using instrumental variables.…”

Section: Analysis Of Administrative Databasesmentioning

confidence: 99%

“…Nine studies examined the impact of adherence on costs without explicit consideration of medication switching, augmentation or excess filling [24][25][26][27]37,38,[40][41][42]. All except one evaluated adherence and costs over the same period; one study evaluated the impact of adherence in the first year on costs in the second [40]. Most report comparisons of cost data without controlling for differences in patient characteristics although one publication matched patients according to length of follow-up and type of insurance [40].…”

Section: Unadjusted Comparisons Across Adherence Groupsmentioning

confidence: 99%

“…All except one evaluated adherence and costs over the same period; one study evaluated the impact of adherence in the first year on costs in the second [40]. Most report comparisons of cost data without controlling for differences in patient characteristics although one publication matched patients according to length of follow-up and type of insurance [40]. Four publications undertook multivariate regression modelling of costs [24][25][26]40].…”

Section: Unadjusted Comparisons Across Adherence Groupsmentioning

confidence: 99%

“…Most report comparisons of cost data without controlling for differences in patient characteristics although one publication matched patients according to length of follow-up and type of insurance [40]. Four publications undertook multivariate regression modelling of costs [24][25][26]40]. The study by Svarstad and colleagues was notable as the only study which assessed adherence from more than one data source [24].…”

Section: Unadjusted Comparisons Across Adherence Groupsmentioning

confidence: 99%

See 4 more Smart Citations

Does Non-Adherence Increase Treatment Costs in Schizophrenia?

Pennington

McCrone

2018

PharmacoEconomics

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Section: Analysis Of Administrative Databasesmentioning

confidence: 99%

Section: Analysis Of Administrative Databasesmentioning

confidence: 99%

Section: Unadjusted Comparisons Across Adherence Groupsmentioning

confidence: 99%

Section: Unadjusted Comparisons Across Adherence Groupsmentioning

confidence: 99%

Section: Unadjusted Comparisons Across Adherence Groupsmentioning

confidence: 99%

See 3 more Smart Citations

Does Non-Adherence Increase Treatment Costs in Schizophrenia?

Pennington

McCrone

2018

PharmacoEconomics

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Associations Between Annual Medicare Part D Low-Income Subsidy Loss and Prescription Drug Spending and Use

Fung,

Price,

Cheng

et al. 2024

JAMA Health Forum

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ImportanceThe Medicare Part D Low Income Subsidy (LIS) program provides millions of beneficiaries with drug plan premium and cost-sharing assistance. The extent to which LIS recipients experience subsidy losses with annual redetermination cycles and the resulting associations with prescription drug affordability and use are unknown.ObjectiveTo examine how frequently annual LIS benefits are lost among Medicare Part D beneficiaries and how this is associated with prescription drug use and out-of-pocket costs.Design, Setting, and ParticipantsIn this cohort study of Medicare Part D beneficiaries from 2007 to 2018, annual changes in LIS recipients among those automatically deemed eligible (eg, due to dual eligibility for Medicare and Medicaid) and nondeemed beneficiaries who must apply for LIS benefits were analyzed using Medicare enrollment and Part D event data. Subsidy losses were classified in 4 groups: temporary losses (&lt;1 year); extended losses (≥1 year); subsidy reductions (change to partial LIS); and disenrollment from Medicare Part D after subsidy loss. Temporary losses could more likely represent subsidy losses among eligible beneficiaries. Multinomial logit models were used to examine associations between beneficiary characteristics and subsidy loss; linear regression models were used to compare changes in prescription drug cost and use in the months after subsidy losses vs before. Analyses were conducted between November 2022 and November 2023.ExposureSubsidy loss at the beginning of each year among subsidy recipients in December of the prior year.Main Outcomes and MeasuresThe main outcomes were out-of-pocket costs and prescription drug fills overall and for 4 classes: antidiabetes, antilipid, antidepressant, and antipsychotic drugs.ResultsIn 2008, 731 070 full LIS beneficiaries (17%) were not deemed automatically eligible (39% were aged &lt;65 years; 59% were female). Nearly all beneficiaries deemed automatically eligible (≥99%) retained the subsidy annually from 2007 to 2018, compared with 78% to 84% of nondeemed beneficiaries. Among nondeemed beneficiaries, disabled individuals younger than 65 years and racial and ethnic minority groups were more likely to have temporary subsidy losses vs none. Temporary losses were associated with an average 700% increase in out-of-pocket drug costs (+$52.72/mo [95% CI, 52.52-52.92]) and 15% reductions in prescription fills (−0.58 fills/mo [95% CI, −0.59 to −0.57]) overall. Similar changes were found for antidiabetes, antilipid, antidepressant, and antipsychotic prescription drug classes. Beneficiaries who retained their subsidy had few changes.Conclusions and RelevanceThe conclusions of this cohort study suggest that efforts to help eligible beneficiaries retain Medicare Part D subsidies could improve drug affordability, treatment adherence, and reduce disparities in medication access.

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No adherencia en pacientes con esquizofrenia y trastorno esquizoafectivo. Estudio prospectivo de variables asociadas y posibles subtipos

Vega,

Acosta,

Saavedra

et al. 2024

Psiquiatría Biológica

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Adherence to Antipsychotic Therapy: Association With Hospitalization and Medicare Spending Among Part D Enrollees With Schizophrenia

Abstract: Adherence to antipsychotics among Medicare Part D enrollees with schizophrenia was associated with significantly lower probability of psychiatric hospitalization and lower hospital expenditures.

Cited by 12 publications

References 15 publications

Does Non-Adherence Increase Treatment Costs in Schizophrenia?

Does Non-Adherence Increase Treatment Costs in Schizophrenia?

Associations Between Annual Medicare Part D Low-Income Subsidy Loss and Prescription Drug Spending and Use

No adherencia en pacientes con esquizofrenia y trastorno esquizoafectivo. Estudio prospectivo de variables asociadas y posibles subtipos

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