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Reductions in Mortality Among Medicare Beneficiaries Following the Implementation of Medicare Part D
April P. Semilla, MS; Fang Chen, PhD; Timothy M. Dall, MS

Reductions in Mortality Among Medicare Beneficiaries Following the Implementation of Medicare Part D

April P. Semilla, MS; Fang Chen, PhD; Timothy M. Dall, MS
The largest contribution to lives saved came from a reduction in deaths attributable to diabetes, CHF, MI, and stroke. Studies have shown that the use of medications to treat diabetes and cardiovascular conditions increased significantly in the post Part D period. Although estimates vary by source, the use of diabetes medicines increased by an estimated 3.7% to 17.9%.21,42 Similarly, utilization rates for statins are reported to have increased by 13% to 22%, and antihypertensive utilization rates by 14% to 29%.7,21

Other studies that have examined the impact of Part D on mortality have been confined to a narrow window of analysis, often focusing only on the effects of the program in the first year or two following implementation.5,12,13 The Briesacher et al study analyzed data through 4 years following Part D implementation, but made strong assumptions regarding the continuation of falling mortality trends from 2000 to 2010.11 The magnitude of our findings is generally consistent with other studies. We estimated a 1.2% decline in annual mortality over 9 years. Huh and Reif estimated a 2.2% decline in the first 2 years of Part D, similar to our finding that the mortality effect was higher in the first few years of Part D.12 Briesacher et al found a decline of approximately 1% in mortality, though their result is not statistically significant.11 Dunn and Shapiro estimated that 21,800 to 25,500 individuals with cardiovascular disease were still alive in mid-2007 because of Part D.13 We estimated that about 20,000 lives were saved in 2006 and 26,000 lives were saved in 2007; this number includes people with diabetes as well as cardiovascular disease.

Strengths and Limitations

Our study is unique in that it uses a microsimulation approach to estimate how improved access to pharmaceuticals that can lower blood pressure, cholesterol levels, and blood glucose levels can reduce the incidence of adverse health events that contribute to mortality. The strengths of using a microsimulation model include the ability to explain the pathway by which Part D benefits those participants who otherwise would have lower access to medications. This approach controls for patient health risk factors to isolate the timing and magnitude of medication use on reducing mortality.

Limitations are largely driven by data challenges. Part D beneficiaries who otherwise would not have comprehensive access to medications cannot directly be identified and observed, so this study used a microsimulation approach that uses published data to make assumptions regarding increased use of medications and effect on health outcomes.

The model does not take into account possible declines in medication persistence. That is, the documented increases in medication use tied to Part D (ie, 29%, 31%, and 22% increases in drug possession rates observed for patients diagnosed with hyperlipidemia, diabetes, and hypertension, respectively)23 might not be sustained over time, thus overestimating the mortality benefits of Part D.43 A more detailed discussion of the strengths and limitations of this microsimulation model are described in depth elsewhere.14,15

CONCLUSIONS

Since the implementation of Part D in 2006, nearly 200,000 Medicare beneficiaries have lived at least 1 year longer, with an average 3.3 year increase in longevity. Reductions in mortality have occurred because of fewer deaths associated with medication-sensitive conditions such as diabetes, CHF, stroke, and MI. 

Author affiliations: IHS Life Sciences, Washington, DC (FC, TMD, APS).
Funding source: This supplement was supported by PhRMA.
Author disclosures: Dr Chen, Mr Dall, and Ms Semilla report serving as consultants for PhRMA.
Authorship information: Concept and design (FC, TMD, APS); acquisition of data (FC, APS); analysis and interpretation of data (FC, TMD, APS); drafting of the manuscript (TMD, APS); critical revision of the manuscript for important intellectual content (TMD, APS); statistical analysis (FC, TMD, APS); administrative, technical, or logistic support (APS); and supervision (TMD).
Address correspondence to: April P. Semilla, MS, 1150 Connecticut Ave NW, Suite 401, Washington, DC 20036. E-mail: april.semilla@ihs.com.
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