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The Costs of Non-Adherence to Oral Antihyperglycemic Medication in Individuals with Diabetes Mellitus and Concomitant Diabetes Mellitus and Cardiovascular Disease in a Managed Care Environment

  • Original Research Article
  • Published:
Disease Management & Health Outcomes

Abstract

Objective: To assess the relationship between diabetic medication adherence, total healthcare costs, and utilization within patients with type 2 diabetes mellitus and concomitant diabetes and cardiovascular disease (CVD).

Research design and methods: This study was a retrospective analysis of pharmacy and medical claims from 1 April 1998 through 31 March 2000 within a managed care organization’s database. Patients were identified who had received an oral antihyperglycemic medication or had a diagnosis of CVD, were continuously enrolled in the health plan, and were ≥30 years of age. The likelihood of an emergency room (ER) or hospital admission and total healthcare costs related to all causes, stratified by antihyperglycemic medication adherence cohort within the diabetes only and diabetes + CVD groups, were examined over 360 days from the date the patient was identified.

Results: For diabetes patients with ≤75, >75 to ≤95, and >95% adherence, adjusted total healthcare costs (from April 1998 to March 2000) were $US5706, $US5314, and $US4835, respectively (p <0.001). Patients with ≤75 and >75 to ≤95% adherence had a 31% and 19% greater chance of a hospital/ER admission than those in the >95% cohort, respectively. Adjusted healthcare costs (from April 1998 to March 2000) for those with ≤75, >75 to ≤95, and >95% adherence within the diabetes + CVD cohort was $US37 648, $US31 547, and $US25 354 (p < 0.001). Patients who were ≤75 and >75 to ≤95% adherent had a 44% and 51% greater chance of a hospital/ER admission than those with >95% adherence, respectively.

Conclusions: Higher adherence to oral antihyperglycemic agents is associated with lower healthcare resource utilization and costs for patients with diabetes only and patients with concomitant diabetes and CVD.

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References

  1. American Diabetes Association. Basic diabetes information [online]. Available from URL: http://www.diabetes.org [Accessed 2002 Aug 30]

  2. American Diabetes Association. Economic consequences of diabetes mellitus in the US in 1997. Diabetes Care 1998; 21: 296–309

    Article  Google Scholar 

  3. Centers for Disease Control and Prevention. Cardiovascular disease [online]. Available from URL: http://www.cdc.gov/nccdphp/cardiov.htm [Accessed 2002 Aug 16]

  4. Gaster B, Hirsch IB. The effects of improved glycemic control on complications in type 2 diabetes. Arch Intern Med 1998; 158: 134–40

    Article  PubMed  CAS  Google Scholar 

  5. Smith TL, Melfi CA, Kesterson JA, et al. Direct medical charges associated with myocardial infarction in patients with and without diabetes. Med Care 1999; 37: AS4–11

    Article  PubMed  CAS  Google Scholar 

  6. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention: diabetes surveillance report, 1999. Atlanta (GA): US Department of Health and Human Services, 1999

    Google Scholar 

  7. Manson JE, Colditz GA, Stampfer MJ, et al. A prospective study of maturity-onset diabetes mellitus and risk of coronary heart disease and stroke in women. Arch Intern Med 1991; 151: 1141–7

    Article  PubMed  CAS  Google Scholar 

  8. Seeman T, de Leon CM, Berkman L, et al. Risk factors for coronary heart disease among older men and women: a prospective study of community-dwelling elderly. Am J Epidemiol 1993; 138: 1037–49

    PubMed  CAS  Google Scholar 

  9. Pan W, Cedres LB, Liu K, et al. Relationship of clinical diabetes and asymptomatic hyperglycemia to risk of coronary heart disease mortality in men and women. Am J Epidemiol 1986; 123: 504–16

    PubMed  CAS  Google Scholar 

  10. Kleinman JC, Donahue RP, Harris MI, et al. Mortality in diabetics in a national sample. Am J Epidemiol 1988; 128: 389–401

    PubMed  CAS  Google Scholar 

  11. Barrett-Connor E, Cohn BA, Wingard DL, et al. Why is diabetes mellitus a stronger risk factor for fatal ischemic heart disease in women than in men? The Rancho Bernardo Study. JAMA 1991; 256: 627–31

    Article  Google Scholar 

  12. Moss SE, Klein R, Klein BE. Cause-specific mortality in a population-based study of diabetes. J Am Public Health 1991; 81: 1158–62

    Article  CAS  Google Scholar 

  13. Malmberg K, Ryden L, Efendic S, et al. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. J Am Coll Cardiol 1995; 26: 57–65

    Article  PubMed  CAS  Google Scholar 

  14. Gilmer TP, O’Connor PJ, Manning WG, et al. The cost to health plans of poor glycemic control. Diabetes Care 1997; 20: 1847–53

    Article  PubMed  CAS  Google Scholar 

  15. International classification of diseases. 9th ed. Geneva: World Health Organization, 1997

  16. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992; 45: 613–9

    Article  PubMed  CAS  Google Scholar 

  17. Morrell RW, Park DC, Kidder DP, et al. Adherence to antihypertensive medications across the life span. Gerontologist 1997; 37: 609–17

    Article  PubMed  CAS  Google Scholar 

  18. Park DC, Hertzog C, Leventhal H, et al. Medication adherence in rheumatoid arthritis patients: older is wiser. J Am Geriatr Soc 1999; 47: 172–93

    PubMed  CAS  Google Scholar 

  19. Raiz LR, Kilty KM, Henry ML, et al. Medication compliance following renal transplantation. Transplantation 1999; 68: 51–5

    Article  PubMed  CAS  Google Scholar 

  20. Claesson S, Morrison A, Wertheimer AI, et al. Compliance with prescribed drugs: challenges for the elderly population. Pharm World Sci 1999; 21: 256–9

    Article  PubMed  CAS  Google Scholar 

  21. Cramer JA. Enhancing patient compliance in the elderly: role of packaging aids and monitoring. Drugs Aging 1998; 12: 7–15

    Article  PubMed  CAS  Google Scholar 

  22. Ennis KJ, Reichard RA. Maximizing drug compliance in the elderly: tips for staying on top of your patients’ medication use. Postgrad Med 1997; 102: 211–34

    Article  PubMed  CAS  Google Scholar 

  23. Savage P. Cardiovascular complications of diabetes mellitus: what we know and what we need to know about their prevention. Ann Intern Med 1996; 124:123–6

    PubMed  CAS  Google Scholar 

  24. The Diabetes Control and Complications Trial Research Group. Effect of intensive diabetes management on macrovascular events and risk factors in the Diabetes Control and Complications Trial. Am J Cardiol 1995; 75: 894–903

    Article  Google Scholar 

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Acknowledgments

Bristol-Myers Squibb Company, Princeton, New Jersey, USA, funded the research described in this manuscript. Researchers from the Pharmacoeconomics and Health Outcomes Research Department of Prescription Solutions, a pharmacy benefit and medical management company, and Bristol-Myers Squibb conducted this study.

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Authors and Affiliations

  1. Prescription Solutions®, 3515 Harbor Boulevard, Mail Stop LC07-264, Costa Mesa, California, CA 92626, USA

    T. Jeffrey White Pharm.D., M.S. (Director of Clinical Research), Ann Vanderplas, Eunice Chang & Geoffrey D. Abrams

  2. Bristol-Myers Medical Affairs, Plainsboro, New Jersey, USA

    Christopher M. Dezii

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  1. T. Jeffrey White Pharm.D., M.S.
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  2. Ann Vanderplas
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  3. Eunice Chang
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  4. Christopher M. Dezii
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Correspondence to T. Jeffrey White Pharm.D., M.S..

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White, T.J., Vanderplas, A., Chang, E. et al. The Costs of Non-Adherence to Oral Antihyperglycemic Medication in Individuals with Diabetes Mellitus and Concomitant Diabetes Mellitus and Cardiovascular Disease in a Managed Care Environment. Dis-Manage-Health-Outcomes 12, 181–188 (2004). https://doi.org/10.2165/00115677-200412030-00004

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