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Agency for Healthcare Research and Quality Advancing Excellence in Health Care Trends in the.

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Presentation on theme: "Agency for Healthcare Research and Quality Advancing Excellence in Health Care Trends in the."— Presentation transcript:

1 Agency for Healthcare Research and Quality Advancing Excellence in Health Care http://www.ahrq.gov http://www.ahrq.govhttp://www.ahrq.gov Trends in the Pharmaceutical Treatment of Diabetes and Implications for Financial Burdens, 1997-2007 Eric Sarpong, Didem M. Bernard and G. Edward Miller AHRQ Annual Conference September 27, 2010

2 Advancing Excellence in Health Care Overview Diabetes is a chronic, progressive and costly disease (2007, $174 billion) Diabetes is a chronic, progressive and costly disease (2007, $174 billion) Trends in anti-diabetic drugs are important Trends in anti-diabetic drugs are important – Increasing disease prevalence – Chronic comorbidities – More aggressive treatments – Newer and more expensive drugs Implications of current trends for out-of-pocket (OOP) financial burdens in non-elderly persons with diabetes Implications of current trends for out-of-pocket (OOP) financial burdens in non-elderly persons with diabetes – High OOP costs due to increased drug spending may: Burden individuals/families Burden individuals/families Prevent timely health services use Prevent timely health services use u Lead to costly long-term complications

3 Advancing Excellence in Health Care Previous Literature on Financial Burdens for Health Care Bernard et al. (2006) found that adults with diabetes: Bernard et al. (2006) found that adults with diabetes: – Had greater risks of high burdens – Had lower incomes – Paid a higher share of total expenditures out-of- pocket Banthin and Bernard (2006) found that between 1996 and 2003: Banthin and Bernard (2006) found that between 1996 and 2003: – Prevalence of high financial burdens increased for the entire the U.S. population and within several subgroups

4 Advancing Excellence in Health Care Objective Part I Part I – Examine trends in anti-diabetic medication use and expenditures – Describe characteristics of persons with diabetes Part II Part II – Examine OOP financial burdens among non- elderly persons with diabetes The Elderly (≥ 65 years) are different The Elderly (≥ 65 years) are different u Have Medicare and mostly unemployed To help inform targeted policies for non- elderly persons, at increased risk of high burdens To help inform targeted policies for non- elderly persons, at increased risk of high burdens

5 Advancing Excellence in Health Care Data Use MEPS for the years 1997 through 2007 Use MEPS for the years 1997 through 2007 – Nationally representative data - U.S. civilian non- institutionalized population – Part I - years 1997 through 2007 – Part II – first year of 2005-2007 panels Detailed information on drug purchases including: Detailed information on drug purchases including: – Therapeutic classifications and quantity purchased – Source of Payment: OOP payments by families OOP payments by families Private and public insurance payments Private and public insurance payments Detailed information on health conditions, economic and socio-demographic variables Detailed information on health conditions, economic and socio-demographic variables

6 Advancing Excellence in Health Care Defining and Measuring OOP Burden using MEPS OOP financial burden = Total family OOP spending Total family OOP spending Total family income Categorize OOP financial burdens using thresholds Categorize OOP financial burdens using thresholds – Individuals have high burden if family OOP ≥ 10% of family income

7 Advancing Excellence in Health Care Part I

8 Advancing Excellence in Health Care Increase in treated prevalence of diabetes, 1997 and 2007. Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 1997and 2007. ** Difference in 1997 and 2007 estimates significant at p <.05.

9 Advancing Excellence in Health Care Increase in comorbid conditions among persons with treatment for diabetes, 1997 and 2007 Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 1997and 2007. ** Difference in 1997 and 2007 estimates significant at p <.05

10 Advancing Excellence in Health Care Changes in diabetes treatment, 1997 and 2007 Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 1997and 2007. ** Difference in 1997 and 2007 estimates significant at p <.05

11 Advancing Excellence in Health Care Changes in use of oral medication classes, 1997 and 2007 Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 1997and 2007. ** Difference in 1997 and 2007 estimates significant at p <.05

12 Advancing Excellence in Health Care Change in total expenditures per user, 1997-1998 and 2006-2007 Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 1997-1998 and 2006-2007. ** Difference in 1997-1998 and 2006-2007 estimates significant at p <.05

13 Advancing Excellence in Health Care Change in out-of-pocket expenditures per user, 1997-1998 and 2006-2007 Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 1997-1998 and 2006-2007. ** Difference in 1997-1998 and 2006-2007 estimates significant at p <.05

14 Advancing Excellence in Health Care Percentage of persons with treatment for diabetes by sex and age, 2006-2007 Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2006-2007. (**), [*] Differences from the reference category significant at (p <.05) and [p <.10]

15 Advancing Excellence in Health Care Percentage of persons with treatment for diabetes by health insurance status and race-ethnicity, 2006-2007 Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2006-2007. (**), [*] Differences from the reference category significant at (p <.05) and [p <.10]

16 Advancing Excellence in Health Care Percentage of persons with treatment for diabetes by education and income, 2006-2007 Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2006-2007. (**), [*] Differences from the reference category significant at (p <.05) and [p <.10]

17 Advancing Excellence in Health Care Summary – Trends in the Pharmaceutical Treatment of Diabetes, 1997 to 2007 Proportion using major classes Proportion using major classes – Increase in oral use – Decrease in insulin use – Introduction of non-insulin injectables Proportion using specific classes of orals: Proportion using specific classes of orals: – Decreased use of (older) sulfonylureas – Increased use of (newer) biguanides and thiazolidinediones (TZDs) Persons most likely to report treatment for diabetes Persons most likely to report treatment for diabetes – Those 65 years and older – Those with public insurance (< 65 years) and Medicare- Medicaid (≥ 65 years) – Non-Hispanic Blacks, the near poor, those with less than high school education and

18 Advancing Excellence in Health Care Part II

19 Advancing Excellence in Health Care Out-of-pocket financial burdens among non-elderly persons with treatment for diabetes by sex and age, 2005-2007 Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, first year of 2005-2007 panel data. (**), [*] Differences from the reference category significant at (p <.05) and [p <.10]

20 Advancing Excellence in Health Care Out-of-pocket financial burdens among non-elderly persons with treatment for diabetes by health insurance status and race- ethnicity, 2005-2007 Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, first year of 2005-2007 panel data. (**), [*] Differences from the reference category significant at (p <.05) and [p <.10]

21 Advancing Excellence in Health Care Out-of-pocket financial burdens among non-elderly persons with treatment for diabetes by education and income, 2005-2007 Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, first year of 2005-2007 panel data. (**), [*] Differences from the reference category significant at (p <.05) and [p <.10]

22 Advancing Excellence in Health Care Out-of-pocket financial burdens among non-elderly persons with treatment for diabetes by type of treatment and comorbid conditions, 2005-2007 Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, first year of 2005-2007 panel data. (**), [*] Differences from the reference category significant at (p <.05) and [p <.10]

23 Advancing Excellence in Health Care Summary – OOP financial burden in the non-elderly diabetes population, 2005-2007 Non-elderly diabetes patients most likely to experience high burden: Non-elderly diabetes patients most likely to experience high burden: – Were: ages 50-64, women, uninsured, poor and Hispanics – Had less than a high school education – Had one or more co-morbidities – Used both insulin/injectables and oral medications

24 Advancing Excellence in Health Care Logit: Dependent variable out-of-pocket financial burdens ≥ 10% Independent Variables Odds Ratios Age in years 0-34 0-341.00 35-49 35-491.69 50 to 64 50 to 642.65** Sex Male Male1.00 Female Female1.27* Race/ethnicity non Hispanic White/other non Hispanic White/other1.00 non-Hispanic Black non-Hispanic Black0.73* Hispanic Hispanic0.79 Health insurance status Any private Any private1.00 Public only Public only0.95 Uninsured Uninsured2.61** Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2005-2007. (**), [*] Differences from the reference category significant at (p <.05) and [p <.10] Independent Variables Odds Ratios Income Poor Poor7.82** Near Poor/Low income Near Poor/Low income4.23** Middle income Middle income3.00** High income High income1.00 Education Less than high school Less than high school1.42* High school High school1.05* At least some college At least some college1.00 Comorbid conditions No comorbid condition No comorbid condition1.00 Any comorbid condition Any comorbid condition1.51** Type of Treatment No anti-diabetic medications No anti-diabetic medications1.00 Injectables and orals Injectables and orals1.65* Injectables -only Injectables -only1.15 One oral class One oral class0.62* Two or more oral classes Two or more oral classes0.88

25 Advancing Excellence in Health Care Summary of Multivariate Analysis: OOP financial burden in the non-elderly diabetes population, 2005-2007 Non-elderly persons with higher odds of high burdens: Non-elderly persons with higher odds of high burdens: – Those ages 50-64, women, uninsured, poor – Had less than a high school education – Had one or more co-morbidities – Used both insulin/injectables and oral medications Non-elderly persons with lower odds of high burdens: Non-elderly persons with lower odds of high burdens: – Were non-Hispanic blacks – Used one oral class of medication – Had high incomes

26 Advancing Excellence in Health Care Conclusions Part I Part I – We highlight: Growing shift away from sulfonylureas towards the use biguanides and thiazolidinediones (TZDs) Growing shift away from sulfonylureas towards the use biguanides and thiazolidinediones (TZDs) Swift diffusion of newer and relatively expensive classes of anti-diabetic drugs Swift diffusion of newer and relatively expensive classes of anti-diabetic drugs – We describe characteristics of persons with diabetes Part II Part II – We shed light on: subpopulations of non-elderly more likely to experience OOP financial burdens subpopulations of non-elderly more likely to experience OOP financial burdens

27 Advancing Excellence in Health Care Conclusions (cont’d) Diabetes prevalence falls disproportionately on the vulnerable in society Diabetes prevalence falls disproportionately on the vulnerable in society – Imposes high financial burden for health care The Affordable Healthcare Act may help alleviate some of the financial burden The Affordable Healthcare Act may help alleviate some of the financial burden Our study will help inform targeted policies and additional subsidies for non-elderly persons Our study will help inform targeted policies and additional subsidies for non-elderly persons – Some may still have difficulties paying for necessary medical care - even with insurance coverage

28 Advancing Excellence in Health Care Limitations and Future Research Limitations: Limitations: – We did not distinguish the different types of diabetes – Our results are descriptive in nature Future research: Future research: – Estimate a causal model

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