Dissertation/Thesis Abstract

Effect of Dosing Regimens on Medication Use, Healthcare Resource Utilization, and Costs in Medicaid Enrolled Type 2 Diabetes Mellitus Patients
by Jayawant, Sujata S., Ph.D., The Ohio State University, 2008, 145; 10631020
Abstract (Summary)

This study aimed to assess the changes in medication adherence, healthcare costs, and healthcare resource utilization associated with dosing regimens (MONO, DUAL, or FDCT) and changes in dosing regimen (to DUAL or FDCT). This was a retrospective cohort study of Medicaid enrollees from 8 states with type 2 diabetes newly starting antidiabetic therapy. Patients were followed for 12 months after initiation of index dosing regimen and after changes in dosing regimen. Data were collected on medication utilization, healthcare costs, hospitalization, and emergency room visits. Demographic, clinical, and economic information was extracted. Multiple log-linear regression analysis was employed to model healthcare costs while multiple logistic regression analysis was utilized to study likelihoods of change in therapy, hospitalizations, and ER visits. Zero-inflated negative binomial and negative binomial regressions were employed to model counts of hospitalization and ER visits respectively.This study compared 79.4% MONO, 14.5% DUAL, and 6.2% FDCT patients. Among patients who changed their therapy, 61.4% shifted to DUAL and 38.6% switched to FDCT. Adherence levels of the groups were comparable to the accepted norm of 80%. FDCT patients had significantly lower adherence as compared to MONO and DUAL patients. FDCT patients also had significantly lower healthcare costs than the other two groups. Patients who had an augmentation to dual therapy had better mediation adherence after the change than those who switched to a fixed-dose combination. Patients who switched to FDCT had significantly lower ER visits than those patients who shifted to DUAL. Age, race, gender, comorbidities, and diabetes-related complications were also significant predictors of the outcomes. Medication adherence was mainly associated with hospitalization and ER visit, which reinforces the importance of adherence in avoiding potential complications in diabetics. The predictive power of the model explaining variance in total annual healthcare costs was reasonably moderate. Patients, healthcare providers, and Medicaid programs can collaborate together to devise strategies to improve patient medication adherence and other outcomes. By considering clinical profile and therapy-related issues of the patients, disease management programs can target patients at-risk for poor outcomes and help them gradually reduce the gap between actual adherence and optimal adherence.

Indexing (document details)
Advisor: Balkrishnan, Rajesh
Commitee: Lacombe, Veronique, Seiber, Eric
School: The Ohio State University
Department: Pharmacy
School Location: United States -- Ohio
Source: DAI-B 78/11(E), Dissertation Abstracts International
Subjects: Pharmacy sciences, Health care management
Keywords: Diabetes, Dosing regimens, Medicaid, Medication use, Outcomes, Pharmaceuticals
Publication Number: 10631020
ISBN: 978-0-355-01325-2
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