Date of Award

2015

Degree Type

Thesis

Degree Name

Master of Science in Pharmaceutical Sciences

Specialization

Health Outcomes

Department

Pharmacy Practice

First Advisor

Stephen Kogut

Abstract

Diabetes mellitus (hereinafter referred to as diabetes) is a serious health concern affecting the daily lives of many Americans in both clinical and financial aspects. Diabetes affects approximately 26 million people of all ages in the United States, and the total estimated medical costs of diagnosed diabetes in the U.S. in 2012 exceeded $200 billion. To obtain better health outcomes, prevent complications, and reduce unnecessary costs, some health insurance plans encourage patients to enroll in diabetes management programs that monitor patient's health status more closely and assist in the adoption of healthy behaviors and habits. The aims of this study are to compare medication adherence rates and total healthcare cost among patients participating in a Diabetes Care Management Incentive Program offered by a commercial health insurer with usual care.

This study was performed using a retrospective cohort study design; subjects were insurance plan members with diabetes using metformin-containing medications. Logistic regression analyses were performed to measure the degree of association between intervention status (i.e. participation in the diabetes incentive program) and adherence rates. The adjusted odds ratio with 95% confidence intervals were reported as the measure of effect. For the total healthcare cost analysis, the Mann-Whitney U test was utilized to evaluate differences between the median intervention and non-intervention cost values.

Odds ratios for rates of achieving medication possession ratio (MPR) of 0.80 or greater among the intervention group as compared with the non-intervention groups were 0.966 (95% CI: 0.739 - 1.264) in the bivariate logistic regression model, 0.995 (95% CI: 0.755 -1.312) in the full logistic regression model, and 1.008 (95% CI: 0.765 - 1.328) in the fitted logistic regression model. Additionally, the mean annual total healthcare cost was $8,827.01 ($735.58 per month) in the intervention group and $10,096.53 ($841.38 per month) in the non-intervention group), yet the difference was not statistically significant (p = 0.2327).

Study results indicate that the medication adherence rates among patients using metformin-containing medications were similar between members who were enrolled in the diabetes management program and members who were not enrolled in the program. However, members participating in the program incurred approximately $2,200 less in annual total healthcare cost.

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