Patients in Low-Income Geographic Areas Are More Sensitive to Cost-Sharing
Increases
PHILADELPHIA, Aug. 19 /PRNewswire-FirstCall/ -- The relationship
between medication adherence and income level may contribute to the
disparities in health observed across socioeconomic groups, according to a
recent study published in the Journal of General Internal Medicine. The
study, funded by GlaxoSmithKline (NYSE: GSK), investigated whether
individuals who reside in low-income areas are more strongly influenced by
rising prescription drug co-payments than individuals residing in higher
income areas.
Effects of Increased Patient Cost Sharing on Socioeconomic Disparities
in Health Care was a multi-year retrospective analysis of insurance claims
data for patients with Type 2 diabetes or congestive heart failure (CHF).
The analysis showed an inverse relationship between co-payment and
medication adherence for most -- although not all -- of the medication
classes. Patients in low-income areas were more sensitive to co-payment
changes than patients in high- or middle-income areas.
For this analysis, income categories were established using zip code
based income measures as a proxy for individual income. The income
categories were as follows: under $30,000; $30,000 to $42,000; $42,000 to
$62,000; and more than $62,000.
The occurrence of disparities in health and healthcare utilization
across US socioeconomic groups has been well documented. The research
suggests that low-income individuals with chronic diseases, such as
diabetes and CHF, have poorer adherence rates -- and they may be less
likely to use recommended medications and procedures to manage their
conditions -- than their more affluent counterparts.(1,2,3,4,5)
Study Details
A total of 29,764 patients with diabetes and 13,081 with CHF met the
criteria for inclusion in the study. Among the diabetes patients, the
average age was 53 years, and 44.4% were female; CHF patients were more
likely to be older (56.5 years). Mean co-payments were $19 for brand-name
drugs and $8 for generic drugs per 30-day supply. For those employers that
changed co-payments during the study period, increases in co-payments
ranged from $0 to about $13.00, with an average of about $4.50.
Key findings of the study included:
-- Results suggest that for each medication class, individuals in
high-income areas were consistently more adherent than individuals in
low-income areas.
-- For both diabetes and CHF, there was a notable decrease in
medication adherence across all drug categories in response to a 10%
increase in drug co-payment, with the largest decreases in adherence
occurring in the lowest income groups.
-- Adherence to statins was particularly sensitive to income, with
diabetes patients in the highest-income group being more than 20% more
adherent than those in the lowest-income category.
-- In high-income areas, CHF patients were over 30% more adherent to
statins than their counterparts in low-income areas. CHF patients in
high-income areas were also substantially more adherent to beta-blockers
than CHF patients in low-income areas.
The study was co-authored by Michael Chernew, PhD (Harvard Medical
School); Teresa B. Gibson, PhD (Thomson Healthcare); Kristina Yu-Isenberg,
PhD, RPh and Michael C. Sokol, MD, MS (GlaxoSmithKline); Allison B. Rosen,
MD, ScD and A. Mark Fendrick, MD (Schools of Medicine and Public Health,
University of Michigan).
Medication Adherence is Essential to Managing Chronic Diseases
Adherence to medications is an important factor in clinical outcomes
for patients with chronic diseases. Poor adherence is a serious problem,
contributing to substantial worsening of disease, complications, death, and
increased healthcare costs.(6) Therefore, improving medication adherence
can be an important step in improving health for those with chronic
diseases. In some cases, greater medication adherence may even result in
lower total medical expenditures.(7)
While the impact of cost-sharing on medication adherence, and in
particular of increasing medication co-payments, has been shown to decrease
use of medications for chronic conditions,(8,9,10) these studies have not
specifically addressed the effect of income on utilization.
"Based on our analysis, it is likely that increased co-payments,
intended to control costs, will exacerbate the disparities seen across
socioeconomic groups," said Michael Chernew, PhD, professor, Department of
Health Care Policy, Harvard Medical School.
The current study complements the results of earlier studies from GSK's
Health Management Innovations team, which indicate that barriers to
medication access should be removed to improve adherence, better manage
chronic conditions, improve health -- and lower total healthcare costs.
These studies, read in the context of the body of literature on medication
adherence, suggest that value-based health management can lead to better
adherence -- and better outcomes for both patients and employers.
"We must encourage employers and health plans to develop benefit
strategies that improve the health of all patients -- especially those with
chronic diseases -- which can lead to lower total healthcare costs," said
Michael C. Sokol, MD, MS, medical director for GSK's Health Management
Innovations team.
The Real Driver of Healthcare Costs -- Chronic Diseases
Today's greatest healthcare threats are chronic conditions, which
require ongoing, patient-centered management. In fact, $3 of every $4 spent
on healthcare in the US(11) goes to treating the 45% of Americans with at
least one chronic disease.(12) As well, according to the Milken Institute,
the seven most common chronic diseases cost the US economy $1.3 trillion
each year -- including both direct and indirect costs.(13)
While employers have often implemented strategies of shifting costs
onto the patient, this is only a short-term economic fix. To lower overall
healthcare costs and improve the health of patients of every socioeconomic
group, the focus must be on the driver of healthcare costs in the US --
chronic diseases.
About GlaxoSmithKline
GlaxoSmithKline, one of the world's leading research-based
pharmaceutical and health care companies, is committed to improving the
quality of human life by enabling people to do more, feel better, and live
longer.
To learn more about value-based health management, visit the Center for
Value-Based Health Management at http://www.CenterVBHM.com.
For the complete study, please visit
http://www.springerlink.com/content/t67005764w4n1432/?p=9824ced896164baeb1b
fb1 d2fb0df706&pi=1 (due to the length of this URL, please copy and paste
it into your web browser)
(1) Rao SV, Kaul P, Newby LK, et al. Poverty, process of care, and
outcome in acute coronary syndromes. JACC. 2003;41(11):1948-54.
(2) Lemstra M, Neudorf C, Opondo J. Health disparity by neighbourhood
income. Can J Public Health. 2006;97(6):435-9.
(3) Schneeweiss S, Soumerai SB, Glynn RJ, Maclure M, Dormuth C, Walker
AM. Impact of reference-based pricing for angiotensin-converting enzyme
inhibitors on drug utilization. CMAJ. 2002;166(6):737-45.
(4) Federman AD, Halm EA, Zhu C, Hochman T, Siu AL. Association of
income and prescription drug coverage with generic medication use among
older adults with hypertension. Am J Manag Care. 2006;12(10):611-8
(5) Piette JD, Heisler M, Wagner TH. Problems paying out-of-pocket
medication costs among older adults with diabetes. Diabetes Care.
2004;27(2):384-91.
(6) Osterberg L, Blaschke T. Adherence to medication. N Engl J Med.
2005;353:487-497.
(7) Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of
medication adherence on hospitalization risk and healthcare cost. Med Care.
2005;43(6):521-30.
(8) Gibson TB, Ozminkowski RJ, Goetzel RZ. The effects of prescription
drug cost sharing: a review of the evidence. Am J Manag Care.
2005;11:730-740.
(9) Lexchin J, Grootendorst P. Effects of prescription drug user fees
on drug and health services use and on health status in vulnerable
populations: a systematic review of the evidence. Int J Health Serv.
2004;34:101-122.
(10) Goldman DP, Joyce GF, Escarce JJ et al. Pharmacy benefits and the
use of drugs by the chronically ill. JAMA. 2004;291:2344-2350.
(11) CDC, "Chronic Disease Overview: Costs of Chronic Disease,"
available at http://www.cdc.gov/nccdphp/overview.htm, accessed October 20,
2006.
(12) American College of Physicians. "Costs and Quality Associated With
Treating Medicare Patients With Multiple Chronic Diseases." Available at
http://www.acponline.org/hpp/costs_quality.pdf. Accessed September 18,
2007. 07.
(13) Devol R and Bedroussian A. An Unhealthy America: The Economic
Burden of Chronic Disease. Milken Institute. October 2007.
SOURCE GlaxoSmithKline
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