Anti-Inflammatory Medication Adherence, Healthcare Utilization and Expenditures among Medicaid and Childrenʼs Health Insurance Program Enrollees with Asthma

Abstract

Although greater adherence was associated with lower rates of ED visits, higher medication expenditures outweighed the savings. The overall low adherence rates suggest that quality improvement initiatives should continue to target adherence regardless of the class of medication used. However, low baseline hospitalization rates may leave little opportunity to significantly decrease costs through better disease management, without also decreasing medication costs.

Medication Adherence and Health Care Utilization in Pediatric Chronic Illness: A Systematic Review

“…34,35 Furthermore, lower percentage of time during which children and adolescents possessed anti-inflammatory medications (medication possession ratio [MPR] = [number of days covered by dispensed medication/365] 3 100) was related to higher odds of an ED visit. 36 Consistent with these findings, a lower percentage of doses taken, as measured by electronic monitoring devices, was associated with increased ED visits. 37 In a study comparing groups of children who had asthma seen in the ED to those seen in asthma clinic, selfreported non-adherence was higher in those seen in the ED.…”

“…34 However, when MPRs for inhaled corticosteroids were calculated and grouped, those with 20% to 49% MPR had increased odds of a hospital admission as compared with those with an MPR of 0% to 19%. 36 MPRs for leukotriene inhibitors were not associated with hospitalizations. 36 Caregiver self-reports of non-adherence to corticosteroids were associated with more hospitalizations in a sample of children who had asthma.…”

“…35,36 These studies did by guest on May 11, 2018 http://pediatrics.aappublications.org/ Downloaded from not differentiate between recommended outpatient visits (eg, regularly scheduled planned clinic visits) and excessive outpatient visits (eg, sick visits that may have been prevented with optimal adherence), and are likely illustrating the relationship between multiple aspects of treatment adherence. Specifically, patients who are non-adherent to 1 aspect of their medical regimen (taking medication) are also more likely to be non-adherent to other parts of their medical regimen (attending regular clinic appointments).…”

“…43 The only study to directly examine costs related to non-adherence indicated that non-adherence was associated with lower per-member, per-month public insurance payments in a sample of children who had asthma. 36 As adherence to medication requires payment for prescriptions, Boylston Herndon et al found that non-adherent children had lower drugrelated costs than children with higher adherence levels. In this study, the costs saved by not filling prescriptions were more than the increased costs of visiting the ED or being hospitalized incurred by these participants.…”

“…In a sample of children who had asthma, the fewer days a child possessed inhaled corticosteroids or leukotriene inhibitors, the less often asthma-related office visits occurred. 36 Similarly, children who had not filled a prescription for a controller medication in the past 3 months were less likely than children who had filled a prescription to have an asthma primary care physician visit. 35 …”