Associations between adherence and outcomes among older, type 2 diabetes patients: evidence from a Medicare Supplemental database
Authors Boye K, Curtis S, Lage M, Garcia-Perez L
Received 22 March 2016
Accepted for publication 17 May 2016
Published 16 August 2016 Volume 2016:10 Pages 1573—1581
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Doris YP Leung
Peer reviewer comments 2
Editor who approved publication: Dr Johnny Chen
Kristina Secnik Boye,1 Sarah E Curtis,1 Maureen J Lage,2 Luis-Emilio Garcia-Perez3
1Global Patient Outcomes and Real World Evidence, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 2HealthMetrics Outcomes Research, LLC, Bonita Springs, FL, 3Global Medical Affairs, Lilly Diabetes, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
Objective: To examine the association between adherence to glucose-lowering agents and patient outcomes, including costs, acute-care resource utilization, and complications, in an older, type 2 diabetic population.
Data and methods: The study used Truven’s Medicare Supplemental database from July 1, 2009 to June 30, 2014. Patients aged 65 years or older were included if they had at least two type 2 diabetes diagnoses and received a glucose-lowering agent from July 1, 2010 through June 30, 2011. Multivariable analyses examined the relationships among 3-year patient outcomes and levels of adherence, proxied by the proportion of days covered. Outcomes included all-cause medical costs, diabetes-related medical costs, acute-care resource utilization, and acute complications.
Results: In this study (N=123,235), higher adherence was linked to reduced costs and improved health outcomes. For example, comparing an individual with adherence of proportion of days covered <20% to one with proportion of days covered ≥80% illustrates an average saving of $28,824 in total 3-year costs. Furthermore, a 1% increase in adherence among 1,000 patients was associated with all-cause savings of $65,464 over 3 years. The probability of a hospitalization, an emergency room (ER) visit, or an acute complication decreased monotonically as adherence levels got higher, as did the number of hospitalizations, ER visits, and days hospitalized (P<0.005).
Conclusion: Higher adherence was associated with substantially less need for acute care, as indicated by a lowered probability of hospitalization or ER use, a reduced risk of an acute complication, and a decreased number of hospitalizations, ER visits, and days hospitalized. Higher adherence was also generally associated with lower all-cause and diabetes-related total costs, despite higher drug costs. These lower total costs were driven by the diminished acute care and outpatient costs. Results suggest that higher glucose-lowering agent adherence is associated with significant benefits for payers and older patients with type 2 diabetes.
Keywords: proportion of days covered, complications, costs, resource utilization, retrospective study
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