Higher Adherence Linked to Lower Total Cost of Care With Newer Antidiabetic Agents: Sam Peasah, PhD, MBA, RPh

Although pharmacy costs increased with higher adherence, medical costs significantly decreased for those moving from 80% to 90% to above 90% adherence, resulting in a lower total cost of care, explains Sam Peasah, PhD, MBA, RPh, director for the Center of High-Value Health Care at the University of Pittsburgh Medical Center (UPMC).

This transcript was lightly edited; captions were auto-generated.

Transcript

Can you discuss the significance of the key findings regarding the cost impact of achieving 80% adherence to newer antidiabetic agents?

I'll just give you a little bit background to why we did a study. We know that 80% has been the threshold that we've used over the years to say that something is optimal. It helps with clinical outcomes. But we were wondering with all the programs that are out there, with pharmacists trying to get patients to be even more adherent, is it worth the squeeze if it should move even beyond the 80% and get into the 90%? We wanted to see whether the cost implications were worth it. That's what set up this whole study.

In this study, what we did was to compare those who were moderately adherent—that means they are below 80%—and then we try to see what happens if they move into above 80% compared to those who stayed in the 70% to 80% [range]. We also looked at those who even were adherent between 80% and 90%, and they even move higher, above 90%. We wanted to see what was the cost implications. As you can expect, the pharmacy cost goes up, because they become more adherent, so they're using more of the medications and it costs a lot more to do that. Then the medical cost was what we were really interested in, whether becoming more adherent will lead to lower medical costs.

We realized that those who were between 70% and 80% who moved to 80% and 90%, there wasn't much so the total cost of care didn't improve that much. That means that their medical costs improved, but it was not enough to overcome the higher pharmacy cost. But when it came to those who were already adherent, they were between 80% and 90%, and then they jumped to at least 90%. We realized that, as expected, the pharmacy costs went out, but there was a huge benefit in the medical cost, where the medical costs became lower for those who improved compared to those who stayed in the same group. The take home here is, if you're adherent in the 80% to 90%, and you become even more adherent above 90%, it is worth the squeeze. Your total cost of care goes down.