Cost-effectiveness of medication therapy management among Medicare population and across racial/ethnic groups.
| Autor: | Tsang CCS; Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN., Wang J; Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN., Shih YT; University of California, Los Angeles, School of Medicine, Los Angeles, CA. |
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| Jazyk: | angličtina |
| Zdroj: | Medicine [Medicine (Baltimore)] 2024 May 03; Vol. 103 (18), pp. e37935. |
| DOI: | 10.1097/MD.0000000000037935 |
| Abstrakt: | Background: Inappropriate medication utilization among older adults is a pressing concern in the United States, owing to its high prevalence and the consequential detrimental impact it engenders. The adverse effects stemming from the inappropriate use of medication may be unequally borne by racial/ethnic minority populations, calling for greater efforts towards promoting equity in healthcare. The study objective was to assess the cost-effectiveness of Medication Therapy Management (MTM) services among Medicare beneficiaries and across racial/ethnic groups. Methods: Medicare administrative data from 2016 to 2017 linked to Area Health Resources Files were used to analyze Medicare fee-for-service patients aged 65 or above with continuous Parts A/B/D coverage. The intervention group included new MTM enrollees in 2017; the control group referred to patients who met the general MTM eligible criteria but did not enroll in 2016 or 2017. The 2 groups were matched using a propensity score method. Effectiveness was evaluated as the proportion of appropriate medication utilization based on performance measures developed by the Pharmacy Quality Alliance. Costs were computed as total healthcare costs from Medicare perspective. A multivariable net benefit regressions with a classic linear model and Bayesian analysis were utilized. Net benefit was calculated based on willingness-to-pay thresholds at various multiples of the gross domestic product in 2017. Three-way interaction terms among dummy variables for MTM enrollment, 2017, and racial/ethnic minority groups were incorporated in a difference-in-differences study design. Results: After adjusting for patient characteristics, the findings indicate that MTM receipt was associated with incremental net benefit among each race and ethnicity. For instance, the net benefit of MTM among the non-Hispanic White patients was $2498 (95% confidence interval = $1609, $3386) at a willingness-to-pay value of $59,908. The study found no significant difference in net benefits for MTM services between minority and White patients. Conclusion: The study provides evidence that MTM is a cost-effective tool for managing medication utilization among the Medicare population. However, MTM may not be cost-effective in reducing racial/ethnic disparities in medication utilization in the short term. Further research is needed to understand the long-term cost-effectiveness of MTM on racial/ethnic disparities. Competing Interests: The following potential conflicts of interest are disclosed. No potential conflict of interest was reported by Chi Chun Steve Tsang. Junling Wang received funding from AbbVie, Curo, Bristol Myers Squibb, Pfizer, and Pharmaceutical Research and Manufacturers of America (PhRMA); and serves as Co-Chair on the Value Assessment-Health Outcomes Research Advisory Committee of the PhRMA Foundation. Ya-Chen Tina Shih reported receiving institutional grants from the Health Care Service Corporation, Blue Cross and Blue Shield of Texas. She received consulting fees, travel support, and accommodations for serving on an advisory board for Sanofi; and is a member of the American Cancer Society Guideline Development Group. (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.) |
| Databáze: | MEDLINE |
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