The effect of cost sharing on employees with diabetes

Department of Policy Analysis and Management, Cornell University, Ithaca, NY 14853, USA.
The American journal of managed care (Impact Factor: 2.26). 01/2007; 12 Spec no.:SP20-6.
Source: PubMed


This article analyzes the financial effect that changing diabetes mellitus drug copayments has on adherence, medical expenditures, absenteeism, and job productivity.

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    • "There is no attempt to value and incorporate any survival or quality-of-life benefit from the patient perspective. In addition, there may be benefits to employers related to reduced illness and absenteeism that our estimates cannot capture because they are focused on the insurer [44]. If these were to be included in the calculus, many additional treatments might be identified as appropriate for VBID. "
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    ABSTRACT: To examine cost responsiveness and total costs associated with a simulated "value-based" insurance design for statin therapy in a Medicare population with diabetes. Four-year panels were constructed from the 1997-2005 Medicare Current Beneficiary Survey selected by self-report or claims-based diagnoses of diabetes in year 1 and use of statins in year 2 (N = 899). We computed the number of 30-day statin prescription fills, out-of-pocket and third-party drug costs, and Medicare Part A and Part B spending. Multivariate ordinary least squares regression models predicted statin fills as a function of out-of-pocket costs, and a generalized linear model with log link predicted Medicare spending as a function of number of fills, controlling for baseline characteristics. Estimated coefficients were used to simulate changes in fills associated with co-payment caps from $25 to $1 and to compute changes in third-party payments and Medicare cost offsets associated with incremental fills. Analyses were stratified by patient cardiovascular event risk. A simulated out-of-pocket price of $25 [$1] increased plan drug spending by $340 [$794] and generated Medicare Part A/B savings of $262 [$531]; savings for high-risk patients were $558 [$1193], generating a net saving of $249 [$415]. Reducing statin co-payments for Medicare beneficiaries with diabetes resulted in modestly increased use and reduced medical spending. The value-based insurance design simulation strategy met financial feasibility criteria but only for higher-risk patients.
    Full-text · Article · May 2012 · Value in Health
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    • "It goes without saying that additional savings will be difficult to obtain unless cost-effective methods are available to increase drug adherence among Medicare beneficiaries with diabetes. Valuebased insurance designs (VBID) with lowered copayments—or even free drugs—have been suggested as one approach to increasing medication utilization rates among diabetics (Rosen et al. 2005; Nicholson 2006; Fitch et al. 2008; Spaulding et al. 2009). At this point, the evidence base on VBID effectiveness is meager and such programs would be difficult to implement under current Medicare payment rules because drug copay policies are made by private Part D prescription drug plans. "
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    ABSTRACT: To measure 3-year medication possession ratios (MPRs) for renin-angiotensin-aldosterone system (RAAS) inhibitors and statins for Medicare beneficiaries with diabetes, and to assess whether better adherence is associated with lower spending on traditional Medicare services controlling for biases common to previous adherence studies. Medicare Current Beneficiary Survey data from 1997 to 2005. Longitudinal study of RAAS-inhibitor and statin utilization over 3 years. The relationship between MPR and Medicare costs was tested in multivariate models with extensive behavioral variables to control for indication bias and healthy adherer bias. Over 3 years, median MPR values were 0.88 for RAAS-I users and 0.77 for statin users. Higher adherence was strongly associated with lower Medicare spending in the multivariate analysis. A 10 percentage point increase in statin MPR was associated with U.S.$832 lower Medicare spending (SE=219; p<.01). A 10 percentage point increase in MPR for RAAS-Is was associated with U.S.$285 lower Medicare costs (SE=114; p<.05). Higher adherence with RAAS-Is and statins by Medicare beneficiaries with diabetes results in lower cumulative Medicare spending over 3 years. At the margin, Medicare savings exceed the cost of the drugs.
    Full-text · Article · Mar 2011 · Health Services Research
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    • "pain, foot ulcers and amputations (Pop-Busui et al., 2006; Said, 2007). Although estimates of diabetic neuropathy vary widely depending on the assessment criteria employed, as many as 50% of people with diabetes have some degree of neuropathic pain (Nicholson, 2006). A large number of neuroanatomical, neurophysiologic , and neurochemical mechanisms are thought to contribute to the development and maintenance of diabetic neuropathic pain (Gidal and Billington, 2006). "
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    ABSTRACT: Diabetic neuropathic pain, an important microvascular complication of diabetes mellitus is recognized as one of the most difficult types of pain to treat. The development of tolerance, inadequate relief and potential toxicity of classical antinociceptives warrant the investigation of the newer agents to relieve this pain. The aim of the present study was to explore the antinociceptive effect of lycopene and its effect on tumour necrosis factor-alpha (TNF-alpha) and nitric oxide (NO) release in streptozotocin induced diabetic mice. Four weeks after a single intraperitoneal injection of streptozotocin (200 mg/kg), mice were tested in the tail immersion and hot-plate assays. Diabetic mice exhibited significant hyperalgesia alongwith increased plasma glucose and decreased body weights as compared with control mice. Lycopene (1, 2 and 4 mg/kg body weight; per oral) treatment, from the 4th to 8th week after streptozotocin injection, significantly attenuated thermal hyperalgesia and the hot-plate latencies. Lycopene also inhibited the TNF-alpha and NO release in a dose dependent manner. These results indicate an antinociceptive activity of lycopene possibly through its inhibitory action on NO and TNF-alpha release and point towards its potential to attenuate diabetic neuropathic pain.
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