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The American Journal of Managed Care June 2018
Prevalence and Predictors of Hypoglycemia in South Korea
Sun-Young Park, PhD; Eun Jin Jang, PhD; Ju-Young Shin, PhD; Min-Young Lee, PhD; Donguk Kim, PhD; and Eui-Kyung Lee, PhD
Initial Results of a Lung Cancer Screening Demonstration Project: A Local Program Evaluation
Angela E. Fabbrini, MPH; Sarah E. Lillie, PhD, MPH; Melissa R. Partin, PhD; Steven S. Fu, MD, MSCE; Barbara A. Clothier, MS, MA; Ann K. Bangerter, BS; David B. Nelson, PhD; Elizabeth A. Doro, BS; Brian J. Bell, MD; and Kathryn L. Rice, MD
A Longitudinal Examination of the Asthma Medication Ratio in Children
Annie Lintzenich Andrews, MD, MSCR; Daniel Brinton, MHA, MAR; Kit N. Simpson, DrPH; and Annie N. Simpson, PhD
Physician Practice Variation Under Orthopedic Bundled Payment
Joshua M. Liao, MD, MSc; Ezekiel J. Emanuel, MD, PhD; Gary L. Whittington, BSBA; Dylan S. Small, PhD; Andrea B. Troxel, ScD; Jingsan Zhu, MS, MBA; Wenjun Zhong, PhD; and Amol S. Navathe, MD, PhD
Simply Delivered Meals: A Tale of Collaboration
Sarah L. Martin, PhD; Nancy Connelly, MBA; Cassandra Parsons, PharmD; and Katlyn Blackstone, MS, LSW
Placement of Selected New FDA-Approved Drugs in Medicare Part D Formularies, 2009-2013
Bruce C. Stuart, PhD; Sarah E. Tom, PhD; Michelle Choi, PharmD; Abree Johnson, MS; Kai Sun, MS; Danya Qato, PhD; Engels N. Obi, PhD; Christopher Zacker, PhD; Yujin Park, PharmD; and Steve Arcona, PhD
Identifying Children at Risk of Asthma Exacerbations: Beyond HEDIS
Jonathan Hatoun, MD, MPH, MS; Emily K. Trudell, MPH; and Louis Vernacchio, MD, MS
Assessing Markers From Ambulatory Laboratory Tests for Predicting High-Risk Patients
Klaus W. Lemke, PhD; Kimberly A. Gudzune, MD, MPH; Hadi Kharrazi, MD, PhD, MHI; and Jonathan P. Weiner, DrPH
Satisfaction With Care After Reducing Opioids for Chronic Pain
Adam L. Sharp, MD, MS; Ernest Shen, PhD; Yi-Lin Wu, MS; Adeline Wong, MPH; Michael Menchine, MD, MS; Michael H. Kanter, MD; and Michael K. Gould, MD, MS
Currently Reading
Cost Sharing for Antiepileptic Drugs: Medication Utilization and Health Plan Costs
Nina R. Joyce, PhD; Jesse Fishman, PharmD; Sarah Green, BA; David M. Labiner, MD; Imane Wild, PhD, MBA; and David C. Grabowski, PhD

Cost Sharing for Antiepileptic Drugs: Medication Utilization and Health Plan Costs

Nina R. Joyce, PhD; Jesse Fishman, PharmD; Sarah Green, BA; David M. Labiner, MD; Imane Wild, PhD, MBA; and David C. Grabowski, PhD
Increased out-of-pocket costs for antiepileptic drugs were associated with decreased adherence, higher healthcare utilization, and higher spending among US commercial health plan beneficiaries with epilepsy.
RESULTS

Study Cohort

A total of 187,241 beneficiaries across 5159 health plans met the study’s eligibility criteria (Figure). The mean number of 90-day periods per beneficiary was 10.4, and median OOP costs as measured by the market-basket index were $0.30 per day. There was a slightly higher percentage of females (54.3%), and 41.7% of beneficiaries were between the ages of 45 and 65 years. Most individuals were the primary beneficiary (42.6%), had a CCI score of 0 (72.4%), and were enrolled in a PPO plan (62.4%) (Table 1).

Outcomes

The mean (SD) PDC over 90-day periods was 0.85 (0.26), and 71.3% of individuals had a 90-day PDC greater than 0.80. The annual PDC was 0.79 (0.23). Analysis of HCU showed that overall and epilepsy-specific inpatient hospitalizations, as well as ED visits, across ​90-day periods were infrequent, whereas the number of outpatient visits overall was higher (Table 2). Mean outpatient spending in a 90-day period made up the largest proportion of overall spending (45.0%). Epilepsy-specific healthcare spending was much lower, accounting for 15.8% of overall health plan spending in a 90-day period (Table 2).

Multivariable Regression

In multivariable linear regression models without health plan fixed effects, higher OOP spending was associated with statistically significant decreases in PDC and inpatient hospitalizations, but an increase in epilepsy-related outpatient visits (Table 3). Similarly, higher OOP spending was associated with an increase in overall spending, both inpatient and outpatient, but not overall epilepsy-specific spending (Table 3). When health plan fixed effects were included in the model, overall plan spending had similar trends and higher coefficients, with the exception of overall epilepsy-specific and total epilepsy-specific outpatient spending. Point estimates for PDC were slightly attenuated from models without health plan fixed effects and were not statistically significant (P = .057) (Table 3). In sensitivity analyses, the direction of results was generally consistent with linear specifications of OOP costs, with the exception of total outpatient costs, which were negatively associated with OOP spending (eAppendix A [eAppendices available at ajmc.com]).

Subgroup Analyses

Several subgroup analyses were conducted to test the robustness of the estimates. All subgroup analyses were fit models without fixed effects. First, when the cohort was limited to newly diagnosed beneficiaries (n = 15,990), no significant associations were found between OOP spending and PDC or healthcare spending, with the exception of total outpatient spending, which was positively associated with OOP spending (eAppendix B). Second, when the top and bottom 1% were trimmed from the total spending values, overall plan spending (coefficient, 169.9; 95% CI, 98.6-241.2; P <.001) was positively associated with OOP costs, whereas total inpatient spending (coefficient, –72.6; 95% CI, –108.5 to –36.7; P <.001), overall epilepsy-specific spending (coefficient, –28.7; 95% CI, –39.3 to –18.2; P <.001), and total epilepsy-specific outpatient spending (coefficient, –7.9; 95% CI, –13.1 to –2.7; P = .003) were negatively associated with OOP costs (eAppendix C).


 
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