• Login
    View Item 
    •   Home
    • UA Graduate and Undergraduate Research
    • UA Theses and Dissertations
    • Dissertations
    • View Item
    •   Home
    • UA Graduate and Undergraduate Research
    • UA Theses and Dissertations
    • Dissertations
    • View Item
    JavaScript is disabled for your browser. Some features of this site may not work without it.

    Browse

    All of UA Campus RepositoryCommunitiesTitleAuthorsIssue DateSubmit DateSubjectsPublisherJournalThis CollectionTitleAuthorsIssue DateSubmit DateSubjectsPublisherJournal

    My Account

    LoginRegister

    About

    AboutUA Faculty PublicationsUA DissertationsUA Master's ThesesUA Honors ThesesUA PressUA YearbooksUA CatalogsUA Libraries

    Statistics

    Most Popular ItemsStatistics by CountryMost Popular Authors

    Impact of Cost-sharing on Utilization of Medications for Secondary Prevention of Cardiovascular Morbidity and Mortality in Medicare Beneficiaries

    • CSV
    • RefMan
    • EndNote
    • BibTex
    • RefWorks
    Thumbnail
    Name:
    azu_etd_11913_sip1_m.pdf
    Size:
    3.539Mb
    Format:
    PDF
    Download
    Author
    Olvey, Eleanor
    Issue Date
    2011
    Keywords
    Medicare
    medications
    secondary prevention
    Pharmaceutical Sciences
    cardiovascular
    cost-sharing
    Advisor
    Skrepnek, Grant H.
    
    Metadata
    Show full item record
    Publisher
    The University of Arizona.
    Rights
    Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
    Abstract
    Purpose: The purpose of this study was to determine the influence of out-of-pocket prescription and healthcare costs on adherence to guideline recommended statins, angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARB), and beta-blockers (BB) used for secondary prevention of coronary heart disease and the associations of adherence with cardiovascular mortality in community-dwelling Medicare beneficiaries ≥ 65 years. Methods: Data from the 2004, 2005, and 2006 Medicare Current Beneficiary Survey (MCBS) was utilized to conduct a retrospective, cross-sectional (i.e., multiple cohort) study. Dependent variables of interest included adherence to statins, ACE/ARBs or BBs, and all-cause mortality, with out-of-pocket (OOP) costs, and adherence to these medications the primary independent variables of interest in these models. Adherence was analyzed as a binary variable with ≥ 80 percent annual adherence the threshold utilized in primary analyses. Total OOP prescription costs for all medications and total OOP healthcare costs borne by the beneficiary were reported. Complex survey design-specified logistic regression with sampling weights was the main statistical analysis used. Sensitivity analyses on adherence thresholds and subgroups were additionally conducted. Results: A significant positive relationship between total OOP prescription costs and statin adherence was identified across observation years in the primary models. Similar relationships were noted for ACE/ARBs and BB in 2004, and ACE/ARBs in 2005. No significant association between adherence and total OOP healthcare costs was indicated in the primary models. Mortality could not be used as a clinical outcome of interest due to limitations with the data. Thus, acute coronary syndrome (ACS) events were used as the clinical outcome. At the ≥ 80 percent threshold, no significant reductions in ACS events were reported. However, various sensitivity analyses did suggest significant reductions in ACS events with ACE/ARBs. Additionally, significantly higher risk of ACS was noted when BB adherence thresholds were reduced to ≥ 60 percent. Conclusions: OOP prescription costs are a significant factor influencing adherence to these medications used for secondary prevention of CAD/MI in Medicare beneficiaries. Continuing to monitor how these costs impact adherence and ultimately outcomes will be critical, particularly given policy changes such as Medicare Part-D.
    Type
    text
    Electronic Dissertation
    Degree Name
    Ph.D.
    Degree Level
    doctoral
    Degree Program
    Graduate College
    Pharmaceutical Sciences
    Degree Grantor
    University of Arizona
    Collections
    Dissertations

    entitlement

     
    The University of Arizona Libraries | 1510 E. University Blvd. | Tucson, AZ 85721-0055
    Tel 520-621-6442 | repository@u.library.arizona.edu
    DSpace software copyright © 2002-2017  DuraSpace
    Quick Guide | Contact Us | Send Feedback
    Open Repository is a service operated by 
    Atmire NV
     

    Export search results

    The export option will allow you to export the current search results of the entered query to a file. Different formats are available for download. To export the items, click on the button corresponding with the preferred download format.

    By default, clicking on the export buttons will result in a download of the allowed maximum amount of items.

    To select a subset of the search results, click "Selective Export" button and make a selection of the items you want to export. The amount of items that can be exported at once is similarly restricted as the full export.

    After making a selection, click one of the export format buttons. The amount of items that will be exported is indicated in the bubble next to export format.