低成本教育信息和处方填写提醒干预提高智力发育障碍和高血压患者服药依从性的成本效益

IF 3.3 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Medical Care Pub Date : 2025-01-01 Epub Date: 2024-12-06 DOI:10.1097/MLR.0000000000001946
Brian Chen, Suzanne McDermott, Deborah Salzberg, Wanfang Zhang, James W Hardin
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引用次数: 0

摘要

背景:患有智力和发育障碍(IDDs)的成人高血压患病率与一般人群相似,但药物不依从率高达50%,而平均为30%。目的:在一项随机对照试验中,评估医疗补助计划成员中患有IDD和高血压的成年人及其助手的教育信息和处方填写提醒的成本效益。研究设计:作者通过从干预前/干预后病例与对照组之间的支出差异中减去每个参与者的干预成本来计算净成本节约。使用自举样本,他们评估了积极成本节约的可能性。他们使用分位数和逻辑回归来检查哪些成员对成本节约做出了贡献,并在基线上确定未来的高成本成员。研究对象:2018年从南卡罗来纳州医疗补助机构招募了112名IDD患者及其助手。措施:采用人工成本和沟通成本确定干预成本。卫生支出从南卡罗来纳的所有付款人索赔数据库中获得,使用实际的医疗补助支出和根据成本收费比率估计的所有付款人总支出。结果:干预的成本为每位会员26.10美元,每位会员在所有付款人支出中分别节省了1008.02美元和1126.42美元,信心分别为78%和91%。在支出超过85百分位的会员中出现了成本节约,而那些在基线上至少两次使用急诊科或住院服务的会员预计将成为未来的高成本会员。结论:干预是节省成本的,保险公司可以前瞻性地识别和定位可能受益的成员。
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Cost-effectiveness of a Low-cost Educational Messaging and Prescription-fill Reminder Intervention to Improve Medication Adherence Among Individuals With Intellectual and Developmental Disability and Hypertension.

Background: Adults with intellectual and developmental disabilities (IDDs) have a similar prevalence of hypertension as the general population, but a higher rate of medication nonadherence at 50% compared with the average of 30%.

Objectives: To assess the cost-effectiveness of educational messaging and prescription-fill reminders to adults with IDD and hypertension and their helpers among Medicaid members in a randomized control trial.

Research design: The authors calculated net cost savings by subtracting per-participant intervention costs from differences in spending between preintervention/postintervention cases versus controls. Using bootstrap samples, they assessed the probability of positive cost savings. They used quantile and logistic regression to examine which members contributed to the cost savings and to identify future high-cost members at baseline.

Subjects: Four hundred twelve members with IDD and their helpers were recruited from the South Carolina Medicaid agency in 2018.

Measures: Intervention costs were determined using labor and communication costs. Health expenditures were obtained from South Carolina's all-payer claims database, using actual Medicaid expenditures and total all-payer expenditures estimated with cost-to-charge ratios.

Results: The intervention, which cost $26.10 per member, saved $1008.02 in all-payer spending and $1126.42 in Medicaid payments per member, respectively, with 78% and 91% confidence. Cost savings occurred among members above the 85th percentile of spending, and those using the emergency department or inpatient services at least twice at baseline were predicted to be future high-cost members.

Conclusions: The intervention is cost-saving, and insurers can prospectively identify and target members who will likely benefit.

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来源期刊
Medical Care
Medical Care 医学-公共卫生、环境卫生与职业卫生
CiteScore
5.20
自引率
3.30%
发文量
228
审稿时长
3-8 weeks
期刊介绍: Rated as one of the top ten journals in healthcare administration, Medical Care is devoted to all aspects of the administration and delivery of healthcare. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of healthcare. This timely journal reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services.
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