Medicaid beneficiaries with congestive heart failure: association of medication adherence with healthcare use and costs.
OBJECTIVE
To examine the association of medication adherence with healthcare use and costs among Medicaid beneficiaries with congestive heart failure (CHF), to investigate whether the association was a graded one, and to estimate the potential savings due to improved adherence.


METHODS
Using Medicare and Medicaid data for 4 states, adherence was estimated using the medication possession ratio (MPR).


METHODS
Multivariate logistic and 2-part general linear models were estimated to study the primary objectives. The MPR was specified in multiple ways to examine its association with healthcare use and costs.


RESULTS
Adherent beneficiaries were less likely to have a hospitalization (0.4 percentage points), had fewer hospitalizations (13%), had in excess of 2 fewer inpatient days (25%), were less likely to have an emergency department (ED) visit (3%), and had fewer ED visits (10%) than nonadherent beneficiaries. Total healthcare costs were $5910 (23%) less per year for adherent beneficiaries compared with nonadherent beneficiaries. The relationship between medication adherence and healthcare costs was graded. For example, beneficiaries with adherence rates of 95% or higher had about 15% lower healthcare costs than those with adherence rates between 80% and less than 95% ($17,665 vs $20,747, P <.01). The relationship between adherence and total healthcare costs was even more stark when the most adherent beneficiaries were segmented into finer subgroups.


CONCLUSIONS
Healthcare costs among Medicaid beneficiaries with CHF would be lower if more patients were adherent to prescribed medication regimens. Researchers should reconsider whether a binary threshold for adherence is sufficient to examine the association of adherence with outcomes and healthcare costs.
Esposito
Dominick
D
Mathematica Policy Research, Inc, Princeton, NJ 08540, USA. desposito@mathematica-mpr.com
Bagchi
Ann D
AD
Verdier
James M
JM
Bencio
Deo S
DS
Kim
Myoung S
MS
D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006333:Heart Failure / Q000188:drug therapy / Q000191:economics*; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008484:Medicaid; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D012044:Regression Analysis; D014481:United States; D016903:Drug Monitoring