The Impact of Payment Scheme Changes on Medication Adherence and Persistence of Patients Diagnosed with Depression in Korea

Abstract

As of 1 July 2018, the Korean National Health Insurance Service (NHIS) changed the fee schedule for individual psychotherapy (IP). We sought to analyze the impact of the IP payment scheme changes on the medication adherence and persistence of patients diagnosed with depression in Korea. We utilized the NHIS claims database from 2017 to 2019. Patients who were newly diagnosed with depression and utilized IP and were prescribed antidepressants during the study period were included. Adherence was measured using the medication possession ratio (MPR), and persistence was measured using the length of therapy (LOT) during the follow-up period. Adherence and persistence during the pre-policy period (before the change of the payment scheme, from January 2018 until June 2018) and the post-policy period (after the change, from July 2018 until December 2019) were compared. During the study period, a total of 176,740 patients with depression were identified. The average MPR significantly increased from 0.20 to 0.33 in the pre- and post-policy periods, respectively (p < 0.001). The average LOT of the patients improved considerably from 36 to 56 days in the pre- and post-policy periods, respectively (p < 0.001). Poisson regression analysis showed that patients with depression who were female, 19–34 years of age (vs. 50–64 years or over 64 years), and in the post-policy period were significantly associated with greater adherence and persistence rates. Payment scheme changes were associated with an increased adherence and persistence of medication use among patients diagnosed with depression.

Sociodemographic and clinical predictors of adherence to antidepressants in depressive disorders: a systematic review with a meta-analysis

“…Of all the selected studies, the majority, 35 (89.7%), included one cohort, three studies (7.69%) included two cohorts ( Stang et al, 2007 ; Kales et al, 2013 ; Shin et al, 2022 ) and one study included three cohorts ( Liu et al, 2010 ). Multiple cohort studies were compared based on characteristics such as the dose or type of medication, ethnicity, and the healthcare insurance coverage (e.g., uninsured, partially or fully insured).…”

“…Four studies ( McLaughlin et al, 2007 ; Stang et al, 2007 ; Yen et al, 2009 ; Yau et al, 2014 ) that evaluated age (continuous) as a predictor found that the treatment adherence rate was higher among older individuals. Among the studies comparing different age groups, one study indicated a higher likelihood of treatment adherence among individuals between the ages of 35–65 compared to younger individuals ( Shin et al, 2022 ). Three other studies also provided similar data, indicating that elderly patients have better adherence rates than patients under 60 years ( Sirey et al, 2001 ), 45 years ( Merrick et al, 2012 ) or 35 years ( Kogut et al, 2016 ) of age.…”

“…Eleven additional studies could not be included in the MA. One of them ( Shin et al, 2022 ) reported that female individuals presented a better treatment adherence rate than male individuals. The rest of the studies ( Lin et al, 1995 ; Lin et al, 2011 ; Cohen et al, 2004 ; Keeley et al, 2007 ; McLaughlin et al, 2007 ; ten Doesschate et al, 2009 ; Wu et al, 2012 ; Kales et al, 2013 ; Gerlach et al, 2017 ; Bhattacharjee et al, 2020 ) did not find significant differences in adherence rates by sex.…”

Exploring patient medication adherence and data mining methods in clinical big data: A contemporary review

“…The study underscored the need for ophthalmologists to particularly address younger male patients to enhance adherence. Concurrently, Shin et al 175 evaluated the influence of psychotherapy payment modifications on medication adherence in Korean patients with depression, leveraging the KNHICD. Their results highlighted superior medication adherence and persistence in women aged 19-34 compared to their counterparts aged 50-64.…”

Function of proprotein convertase subtilisin/kexin type 9 and its role in central nervous system diseases: An update on clinical evidence

“…The incidence of depression, which has increased by 25% since the COVID‐19 pandemic, is often associated with physical illness, loss of occupational function, and low quality of life issues, and could also lead to high rates of suicide (Shin & Bae, 2023). Therefore, the discovery of the relationship between PCSK9 and depression can help the careful use of PCSK9 inhibitors in this population and prevent various problems that may occur.…”