title: A systematic review of value-based insurance design in chronic diseases.
abstract: Value-based insurance design (V-BID) is an insurance cost-sharing model in which patients pay less for medications deemed to be of higher value. Our objective was to determine the association between V-BID and medication adherence, clinical outcomes, healthcare utilization, and spending in patients with or at risk for cardiovascular chronic diseases, compared with no differential lowering of drug co-payments.
  
  
  
  Systematic review.
  
  
  
  We searched PubMed, MEDLINE, EMBASE, CINAHL, Cochrane Controlled Trials Register, Current Controlled Trials, and reference lists of included studies and relevant reviews up to September 2012. Two reviewers independently identified primary research studies with the following study designs: randomized controlled trial, interrupted time series, and controlled before-after studies. Two reviewers independently extracted data and assessed quality.
  
  
  
  Ten studies were identified: 1 high-quality randomized controlled trial, 1 interrupted time series analysis, and 8 controlled before-and-after studies. Heterogeneity in study populations and interventions, overall low study quality, and lack of standard error reporting precluded meta-analysis. All reported improvement in medication adherence for medications subject to V-BID, of between 2 and 5 percentage points. Impact on clinical outcomes was unclear, with only 1 study reporting on this, noting no difference in the primary outcome, but a reduction in adverse secondary outcomes with V-BID. Of the four studies that examined the impact of VBID on healthcare expenditures, V-BID tended to increase overall prescription drug spending, though three of the four studies reported similar overall healthcare costs due to decreased non drug medical spending.
  
  
  
  V-BID is associated with improved medication adherence but its effects on clinical outcomes, healthcare utilization, and spending remain uncertain.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Tang
authors.forename: Lianne
authors.initials: L
authors.lastname: Barnieh
authors.forename: Bikaramjit
authors.initials: B
authors.lastname: Mann
authors.forename: Fiona
authors.initials: F
authors.lastname: Clement
authors.forename: David J T
authors.initials: DJ
authors.lastname: Campbell
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Hemmelgarn
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.forename: Diane
authors.initials: D
authors.lastname: Lorenzetti
authors.forename: Braden J
authors.initials: BJ
authors.lastname: Manns
mesh_terms: D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000628:therapy; D002908:Chronic Disease / Q000188:drug therapy / Q000628:therapy*; D017047:Cost Sharing / Q000191:economics / Q000379:methods; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000458:organization & administration*; D055118:Medication Adherence; D062505:Value-Based Purchasing / Q000191:economics / Q000458:organization & administration*