Healthcare utilization and costs associated with changes in medication adherence around the 80% threshold in patients with cardiovascular disease

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BACKGROUND: Health care utilization and cost impacts, of medication adherence above or below the 80% threshold, remains unclear for cardiometabolic medications. OBJECTIVE: To evaluate the differences in cardiovascular-related emergency department (ED) visits and total cost-of-care associated with changes in medication adherence around the 80% threshold. METHODS: Retrospective observational analysis of claims spanning from Jan 1, 2021, to June 30, 2023. Patients aged 50-80 years with a history of cardiovascular disease and specific cardiometabolic medications were followed for 12 months, and prepost index-fill outcomes compared. Patients were categorized into pre- and postindex groups: 3 pre-index groups (Pre1-moderate, Pre2-high, Pre3-very-high) based on their pre-index 12-month adherence [postindex adherence (PDC)] and 4 post-index groups based on postindex PDC (Post0-low, Post1-moderate, Post2-high, Post3-very-high), for 4 medication classes (antidiabetics, direct oral coagulants [DOACs], antiplatelets, and antiheart-failure meds [HF]). Group definitions: Post0-low (PDC ≤ 69%), Pre1-moderate or Post1-moderate (PDC 70-<80%), Pre2-high or Post2-high (PDC 80-<90%), and Pre3-very-high or Post3-very-high (PDC ≥ 90). Outcomes included per-member-per-year total cost-of-care, and cardiovascular-related ED visits. RESULTS: There were 55,934 (antidiabetics), 46,290 (DOACs), 65,659 (antiplatelets), and 49, 670 (HF) patients in the final sample. Most of the patients in the HF (46%-53%) and DOAC (51%-57%) groups were in the 70+ age group. Among patients in the antidiabetic (45%-47%) and antiplatelet (39%-43%) groups, the majority were in the 60-69 age group. In general, patients who moved from a lower adherence group to a higher adherence group had lower total cost-of-care in almost all groups and medication classes. Moving from PDC ≥ 90 to PDC <90%, total cost-of-care was higher in all 4 medication classes. CONCLUSION: Improving adherence to and beyond the traditional 80% target was associated with lower total cost-of-care.

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