Adherence To Insulin Theapy May Substantially Reduce Costs Associated With Health Resource Utilization Among Insulin Pen Users With Type Ii Diabetes Mellitus

Abstract

To compare overall and diabetes-related health care utilization and expenditures in Medicare beneficiaries with diabetes prior to and after implementation of Part D. METHODS: Data were from the 2001-2010 Medical Expenditure Panel Survey. Medicare beneficiaries aged ≥65 years with selfreported diabetes were identified, excluding individuals who were Medicare-Medicaid dual eligible, had TRICARE, or other public coverage. The outcomes included overall and diabetes-related prescriptions, medical services utilization, and expenditures as well as out-of-pocket costs. These outcomes were analyzed using generalized linear model regression models with a log-link and gamma (for costs) or Poisson (utilization) distribution. All expenditures were inflated to 2010 dollars. STATA survey commands were used to account for the complex survey design. RESULTS: There were 21,864 eligible Medicare beneficiaries with diabetes that comprised the sample population. After adjusting for sociodemographic characteristics and health status, implementation of Part D was associated with decreased out-of-pocket expenditures for insulin (Coeff.:-0.577, p<0.05) and oral antidiabetic agents (Coeff.:-1.292, p<0.001). No statistically significant effect on total health care and prescription expenditures were found. Implementation of Part D was associated with increased number of prescriptions filled (Coeff.: 0.145, p<0.001) without increase in emergency room visits or inpatient stays. CONCLUSIONS: The implementation of Medicare Part D increased medication use and reduced out-of-pocket costs for elderly diabetes patients. This reduction would allow for enhanced access to necessary medications, and thereby may have a positive impact on adherence and health outcomes.

Adherence to and persistence with antidiabetic medications and associations with clinical and economic outcomes in people with type 2 diabetes mellitus: A systematic literature review

“…Only full publications reporting data on the associations between adherence/persistence and the clinical/economic outcomes of interest were prioritized for data extraction and are the focus of this manuscript (n = 92) 21‐112 . The remaining 171 publications (conference abstracts [n = 47] and full publications reporting estimates of adherence/persistence but not associations with clinical/economic outcomes [n = 124]) were excluded.…”

“…Of the 92 full publications included, 21‐112 39 studies were published from 2010 to 2015 and 53 from 2016 to 2020. Most of the studies were retrospective observational cohort studies or database analyses; only 13 of the 92 studies (14%) were prospective 21,23,33,45,59,67,70,87,92,93,97,102,111 .…”

“…In total, 71 studies included estimates of adherence (cited in Table S3). There was variation in how adherence was defined: 30 studies used PDC 22,28‐31,34,36‐39,48,50,56,57,60,63,71,75,76,78‐80,82,83,85,86,88,98,100,110 and 26 studies used the MPR 23,29,32,33,35,41,42,44,49,51,53‐55,64,68,73,77,90,91,95,101,103,104,106,108,109 . MPR is calculated as the total days' supply of treatment in the defined period, divided by the total number of days in the defined period.…”

“…Despite substantial heterogeneity across studies, greater adherence was generally associated with lower inpatient admission costs but higher pharmacy costs. 26,[28][29][30]33,34,39,41,49,72,76,88 Most studies found that total healthcare expenditure in adherent patients was lower than 28,32,39,49,53,54,72,88 or similar to 23,26,34,76 that in nonadherent patients (Figure 2), but in two studies adherence was associated with higher total costs than nonadherence. 30,33 In total, 11 studies reported data on healthcare costs associated with persistence on insulin, 24,25,40,52,61,77,89,96,107 injectable GLP-1RAs 30 and/or combination therapies.…”

Patient Satisfaction with a Dedicated Infusion Pump for Subcutaneous Treprostinil to Treat Pulmonary Arterial Hypertension

“…Patients’ adherence to treatment is a key factor for improving chronic disease control (including destabilization of one clinical condition), efficient use of healthcare resources, and for reducing disease costs [ 24 , 25 ]. Patients’ attitudes and adherence towards their medicines are influenced by many factors, including their perceived (or real) benefits and drawbacks, previous experience of use, perceptions of their illness, satisfaction with treatment, and personal preferences [ 26 ].…”