• 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

    Examining Thresholds for Diabetes, Renin-Angiotensin System Antagonist, and Statin Medication Adherence Quality Measures: The Application of the Law Of Diminishing Returns in Administrative Claims

    • CSV
    • RefMan
    • EndNote
    • BibTex
    • RefWorks
    Thumbnail
    Name:
    azu_etd_16930_sip1_m.pdf
    Embargo:
    2023-12-10
    Size:
    8.123Mb
    Format:
    PDF
    Download
    Author
    Campbell, Patrick James
    Issue Date
    2019
    Keywords
    adherence measure
    adherence thresholds
    economic outcomes
    health policy
    medication adherence
    quality measures
    Advisor
    Warholak, Terri L.
    
    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, presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
    Embargo
    Release after 12/10/2023
    Abstract
    Objective: Despite the limited evidence, a threshold of 80% proportion of days covered (PDC) is used to categorize medication adherence. The objective of this study was to assess the association of 1) antidiabetic, 2) renin-angiotensin system antagonists (RASA), and 3) statin medication adherence, at deciles of PDC, with disease-specific and all-cause economic outcomes (inpatient utilization and total healthcare costs) to identify optimal medication adherence thresholds using the law of diminishing returns. Methods: This retrospective cohort study included individuals from the Truven Health MarketScan® Commercial Claims and Encounters Research Databases (2010-2012) eligible for inclusion in the Pharmacy Quality Alliance diabetes, RASA, and statin medication adherence measures with non-capitated health plans. Generalized linear models (GLMs) with log link and gamma (costs) or negative binomial (utilization) distributions were used to assess the relationship of adherence with economic outcomes while adjusting for covariables (e.g., age, gender, Charlson comorbidity index). An alpha level of 0.01 was set a priori. Beta coefficients were used to compute use ratios and cost ratios and plotted to generate use and cost reduction functions. Marginal use and cost reduction curves were estimated and points of diminishing marginal returns and maximum returns were identified. Results: A total of 404,108 (diabetes), 1,329,576 (RASA), and 1,266,066 (statin) individuals were included in the study cohorts. Of the 120 GLMs that assessed the relationship between adherence and economic outcomes, 116 significant associations were identified (all p<0.0001). Of these, 98 models identified that adherence was associated with lower cost and utilization compared to nonadherence. Eighteen models showed adherence was associated with higher healthcare costs than nonadherence. The following adherence thresholds were identified as the optimal range of medication adherence thresholds (i.e., points of diminishing marginal and maximum returns): between 86% and 91% PDC for diabetes, 83% and 89% PDC for RASA, and 90% and 96% PDC for statin medications. Conclusions: The law of diminishing returns can be successfully applied to medication-taking behavior to derive optimal adherence thresholds in a commercially-insured patient population. Reliance on the 80% PDC adherence threshold should be re-evaluated to optimize benefits of diabetes, RASA, and statin medication adherence. The application of the law of diminishing returns in other patient populations and medication classes is warranted.
    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.