title: Adherence to Oral Antihyperglycemic Agents Among Older Adults With Mental Disorders and Its Effect on Health Care Costs, Quebec, Canada, 2005-2008.
abstract: BACKGROUND
  Nonadherence to oral antihyperglycemic agents (OHAs) leads to an increase in use of health care resources and overall expenditures due to type 2 diabetes and its complications. People with type 2 diabetes are almost twice as likely to have anxiety and depression as the general population. Our aim was to examine health care costs associated with adherence to OHAs and the effect of depression and anxiety disorders on these in older adults with type 2 diabetes.
  
  
  METHODS
  We used data from a representative sample (N = 2,811) of community-dwelling adults in Quebec aged 65 years or older who participated in the Étude sur la Santé des Aînés survey. The final sample consisted of 301 participants who were diagnosed with type 2 diabetes and who were taking OHAs. Total health care costs were calculated as the sum of the costs of hospitalizations and outpatient clinic services. Adherence to OHAs was measured using the medication possession ratio. Depression and anxiety disorders were assessed using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. We also analyzed data by the Charlson Comorbidity Index, age, sex, education, and marital status, using generalized linear models.
  
  
  RESULTS
  Nonadherence among people without depression or anxiety was associated with higher total health care costs ($4,477; 95% confidence interval [CI], $3,754-$5,201; P < .001), as was nonadherence among people with depression or anxiety ($11,124; 95% CI, $9,685-$12,562; P < .001).
  
  
  CONCLUSIONS
  Improving adherence to OHAs among people with type 2 diabetes, particularly those with underlying mental disorders such as depression or anxiety, can decrease health care costs.
authors.affiliation: 150 Place Charles-LeMoyne, Suite 200, PO Box 11, Longueuil, Quebec J4K 0A8, Canada. Email: Lia.Gentil@USherbrooke.ca.
authors.forename: Lia
authors.initials: L
authors.lastname: Gentil
authors.affiliation: Faculty of Medicine and Health Sciences, University of Sherbrooke, and Charles LeMoyne Hospital Research Center, Longueuil, Quebec, Canada.
authors.forename: Helen-Maria
authors.initials: HM
authors.lastname: Vasiliadis
authors.affiliation: Faculty of Medicine and Health Sciences, University of Sherbrooke, and Charles LeMoyne Hospital Research Center, Longueuil, Quebec, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Préville
authors.affiliation: Charles LeMoyne Hospital Research Center, Longueuil, Quebec, Canada.
authors.forename: Djamal
authors.initials: D
authors.lastname: Berbiche
mesh_terms: D000368:Aged; D001007:Anxiety / Q000150:complications; D003863:Depression / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000191:economics*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006306:Health Surveys; D006760:Hospitalization; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D011792:Quebec; D016903:Drug Monitoring
chemical_list: D007004:Hypoglycemic Agents