Does medication adherence following a copayment increase differ by disease burden?
Does medication adherence following a copayment increase differ by disease burden?
复制标题
共付额增加后的药物依从性是否因疾病负担而异？
DOI：
10.1111/j.1475-6773.2011.01286.x
复制
发表时间：
2011
影响因子：
3.4
通讯作者：
Maciejewski,MatthewL
中科院分区：
文献类型：
--
作者：
Wang,Virginia;Liu,Chuan-Fen;Bryson,ChristopherL;Sharp,NancyD;Maciejewski,MatthewL
目的。比较共付额增加后高或低合并症负担患者的药物依从性变化。方法。我们在四个退伍军人事务部 (VA) 医疗中心进行了一项回顾性观察研究，通过比较需要支付共付额的患有高血压或糖尿病的退伍军人与倾向得分匹配的免于共付额的退伍军人。疾病队列按诊断成本组风险评分进行分层：低（<1）和高合并症（>1）负担。 2001 年 2 月至 2003 年 12 月的用药依从性是根据基于 ReComp 算法的 VA 药房索赔数据构建的，并使用广义估计方程进行评估。 结果。 合并症较低的退伍军人比合并症较高的退伍军人对增加 5 美元的共付额更敏感。在合并症较低的群体中，患有糖尿病的退伍军人比患有高血压的退伍军人的依从性下降幅度更大。对于具有较高合并症的免共付额和非豁免退伍军人来说，依从性趋势相似。结论：药物共付额的增加对低风险和高风险患者有不同的影响。高风险患者因持续依从而承担更大的自付费用，而低风险患者则因更不依从而面临更大的不良健康事件风险。
Objectives.To compare changes in medication adherence between patients with high‐ or low‐comorbidity burden after a copayment increase.Methods.We conducted a retrospective observational study at four Veterans Affairs (VA) medical centers by comparing veterans with hypertension or diabetes required to pay copayments with propensity score‐matched veterans exempt from copayments. Disease cohorts were stratified by Diagnostic Cost Group risk score: low‐ (<1) and high‐comorbidity (>1) burden. Medication adherence from February 2001 to December 2003, constructed from VA pharmacy claims data based on the ReComp algorithm, were assessed using generalized estimating equations.Results.Veterans with lower comorbidity were more responsive to a U.S.$5 copayment increase than higher comorbidity veterans. In the lower comorbidity groups, veterans with diabetes had a greater reduction in adherence than veterans with hypertension. Adherence trends were similar for copayment‐exempt and nonexempt veterans with higher comorbidity.Conclusion.Medication copayment increases are associated with different impacts for low‐ and high‐risk patients. High‐risk patients incur greater out‐of‐pocket costs from continued adherence, while low‐risk patients put themselves at increased risk for adverse health events due to greater nonadherence.