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BACKGROUND/RATIONALE:
Type 2 diabetes is a chronic debilitating condition that is associated with significant morbidity, mortality, and health care costs. Ethnic minority populations, notably African Americans and Hispanics, bear an inordinate burden from the disease as reflected by the higher occurrence of disease sequelae such as amputations, loss of vision, and premature mortality. Effective control of diabetes requires treatment with multiple agents and adherence to these medications is critical to achieve recommended glycemic, blood pressure, and lipid goals. A recent systematic review showed that up to 50% of patients with diabetes are non-adherent to medications. However, there are no studies that have examined MNA and its relationship with racial/ethnic differences in health care costs and mortality among veterans with diabetes. Most prior studies in diabetics have utilized a cross-sectional design without considering the within-subject variation through time, few studies have examined mortality and costs as outcomes, and none of these studies have been conducted in veterans. Thus, there are significant gaps in knowledge on the relationship between MNA, race/ethnicity and subsequent health care costs and mortality in veterans with type 2 diabetes.
OBJECTIVE(S):
The primary objectives of this study are to characterize MNA across racial/ethnic groups of elderly (age 65) diabetic veterans, to determine the longitudinal effect of MNA on health care costs to the VA and Medicare (federal payer) and mortality across racial/ethnic groups, and to determine whether racial/ethnic variations in MNA explain racial/ethnic disparities in health care cost and mortality among elderly veterans with diabetes. We will address these goals through three specific aims: 1) to determine racial/ethnic differences in MNA in elderly veterans with type 2 diabetes after controlling for relevant covariates, 2) to determine the effect of MNA on health care costs across racial/ethnic groups over time, and 3) to determine the effect of MNA on mortality across racial/ethnic groups over time.
METHODS:
A cohort of elderly veterans (age 65) with type 2 diabetes will be developed using VA/Medicare-linked national data. We will obtain permission to link VA/Medicare data from VIREC with Austin automated data using real social security numbers. Race/ethnicity will be defined using established guidelines.
The measurement of MNA will be calculated as the summation (in days) of excessive refill gaps over multiple intervals within each year. For sensitivity analyses, MNA will be calculated as the Medication Possession Ratio (MPR) and the MPR at a fixed point in time. Cost will be computed using DSS costing methodologies. Univariate analysis and multivariate regression modeling (including Mixed models and Cox-Proportional Hazard models) will be used for this project.
FINDINGS/RESULTS:
Enter text here.
IMPACT:
This proposal will estimate the financial impact to the federal payer (VA and Medicare) of medication non-adherence (MNA) among elderly veterans with type 2 diabetes and whether there are cost and mortality differentials through time and across different racial/ethnic groups. We will evaluate the natural history (within-subject variation) of MNA through time and its' effect on outcomes (mortality and costs). The results of this longitudinal study will provide critical knowledge to develop simple, culturally appropriate, and cost-effective interventions to decrease MNA in veterans with type 2 diabetes using administrative pharmacy data.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Special (Underserved, High Risk) Populations
DRE:
Resource Use and Cost, Treatment
Keywords:
Cost, Diabetes, Adherence
MeSH Terms:
none
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