Pharmacy costs and glycemic control in the Department of Veterans Affairs.
OBJECTIVE
To determine pharmacy costs for glycemic treatment and its relationship to glycemic control in the Department of Veterans Affairs (VA) between 1994 and 2000.


METHODS
Patients with diabetes in the VA in FY1994, FY1996, FY1998, and FY2000 were identified using an ambulatory care pharmacy-derived database. Total drug acquisition costs, as well as expenditures for insulin, oral glycemic control agents, and self-blood glucose monitoring strips, were determined for these veterans. HbA(1c) levels for the corresponding time periods were also obtained. Pharmacy costs (medications and monitoring) were examined by glycemic control treatment type.


RESULTS
In FY2000, 18% (n = 535,016) of all VA pharmacy patients were identified as having diabetes, and they received 30% of all pharmacy prescriptions. Overall, 23% of pharmacy expenditures for these patients were related to glycemic control medications and monitoring supplies. Annual pharmacy costs increased from FY1994 to FY2000. The greatest change was the higher expenditure for monitoring supplies through FY1998, which then decreased in FY2000. Increased pharmacy costs were associated with improved glycemic control. In FY2000, the mean last HbA(1c) level (n = 446,384) fell to 7.6% from 7.8% in FY1998 (n = 204,136) and 8.4% in 1996 (n = 53,348).


CONCLUSIONS
Diabetes was associated with high pharmacy costs. Increasing medication expenditures were associated with improved HbA(1c) levels at the aggregated national level. Policies concerning dispensing monitoring supplies and several diabetes quality improvement projects were initiated during this interval. Future challenges include initiatives to further optimize care while controlling costs.
Weinstock
Ruth S
RS
VA Healthcare Network Upstate New York, Syracuse, New York, USA. weinstor@upstate.edu
Hawley
Gerald
G
Repke
Denis
D
Feuerstein
Barbara L
BL
Sawin
Clark T
CT
Pogach
Leonard M
LM
D001774:Blood Chemical Analysis / Q000191:economics*; D001786:Blood Glucose; D015190:Blood Glucose Self-Monitoring / Q000191:economics*; D003365:Costs and Cost Analysis; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy* / Q000191:economics*; D017850:Economics, Pharmaceutical; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use; D010594:Pharmacies / Q000191:economics; D014481:United States; D014493:United States Department of Veterans Affairs / Q000191:economics*
D001786:Blood Glucose; D007004:Hypoglycemic Agents