Association between drug insurance cost sharing strategies and outcomes in patients with chronic diseases: a systematic review.

<h4>Background</h4>Prescription drugs are used in people with hypertension, diabetes, and cardiovascular disease to manage their illness. Patient cost sharing strategies such as copayments and deductibles are often employed to lower expenditures for prescription drug insurance plans, but...

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Autores principales:	Bikaramjit S Mann, Lianne Barnieh, Karen Tang, David J T Campbell, Fiona Clement, Brenda Hemmelgarn, Marcello Tonelli, Diane Lorenzetti, Braden J Manns
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/4c17e3a22b2542f4b3ddb4fe630471c7
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spelling	oai:doaj.org-article:4c17e3a22b2542f4b3ddb4fe630471c72021-11-18T08:26:25ZAssociation between drug insurance cost sharing strategies and outcomes in patients with chronic diseases: a systematic review.1932-620310.1371/journal.pone.0089168https://doaj.org/article/4c17e3a22b2542f4b3ddb4fe630471c72014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24667163/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Prescription drugs are used in people with hypertension, diabetes, and cardiovascular disease to manage their illness. Patient cost sharing strategies such as copayments and deductibles are often employed to lower expenditures for prescription drug insurance plans, but the impact on health outcomes in these patients is unclear.<h4>Objective</h4>To determine the association between drug insurance and patient cost sharing strategies on medication adherence, clinical and economic outcomes in those with chronic diseases (defined herein as diabetes, hypertension, hypercholesterolemia, coronary artery disease, and cerebrovascular disease).<h4>Methods</h4>Studies were included if they examined various cost sharing strategies including copayments, coinsurance, fixed copayments, deductibles and maximum out-of-pocket expenditures. Value-based insurance design and reference based pricing studies were excluded. Two reviewers independently identified original intervention studies (randomized controlled trials, interrupted time series, and controlled before-after designs). MEDLINE, EMBASE, Cochrane Library, CINAHL, and relevant reference lists were searched until March 2013. Two reviewers independently assessed studies for inclusion, quality, and extracted data. Eleven studies, assessing the impact of seven policy changes, were included: 2 separate reports of one randomized controlled trial, 4 interrupted time series, and 5 controlled before-after studies.<h4>Findings</h4>Outcomes included medication adherence, clinical events (myocardial infarction, stroke, death), quality of life, healthcare utilization, or cost. The heterogeneity among the studies precluded meta-analysis. Few studies reported the impact of cost sharing strategies on mortality, clinical and economic outcomes. The association between patient copayments and medication adherence varied across studies, ranging from no difference to significantly lower adherence, depending on the amount of the copayment.<h4>Conclusion</h4>Lowering cost sharing in patients with chronic diseases may improve adherence, but the impact on clinical and economic outcomes is uncertain.Bikaramjit S MannLianne BarniehKaren TangDavid J T CampbellFiona ClementBrenda HemmelgarnMarcello TonelliDiane LorenzettiBraden J MannsPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 3, p e89168 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Bikaramjit S Mann Lianne Barnieh Karen Tang David J T Campbell Fiona Clement Brenda Hemmelgarn Marcello Tonelli Diane Lorenzetti Braden J Manns Association between drug insurance cost sharing strategies and outcomes in patients with chronic diseases: a systematic review.
description	<h4>Background</h4>Prescription drugs are used in people with hypertension, diabetes, and cardiovascular disease to manage their illness. Patient cost sharing strategies such as copayments and deductibles are often employed to lower expenditures for prescription drug insurance plans, but the impact on health outcomes in these patients is unclear.<h4>Objective</h4>To determine the association between drug insurance and patient cost sharing strategies on medication adherence, clinical and economic outcomes in those with chronic diseases (defined herein as diabetes, hypertension, hypercholesterolemia, coronary artery disease, and cerebrovascular disease).<h4>Methods</h4>Studies were included if they examined various cost sharing strategies including copayments, coinsurance, fixed copayments, deductibles and maximum out-of-pocket expenditures. Value-based insurance design and reference based pricing studies were excluded. Two reviewers independently identified original intervention studies (randomized controlled trials, interrupted time series, and controlled before-after designs). MEDLINE, EMBASE, Cochrane Library, CINAHL, and relevant reference lists were searched until March 2013. Two reviewers independently assessed studies for inclusion, quality, and extracted data. Eleven studies, assessing the impact of seven policy changes, were included: 2 separate reports of one randomized controlled trial, 4 interrupted time series, and 5 controlled before-after studies.<h4>Findings</h4>Outcomes included medication adherence, clinical events (myocardial infarction, stroke, death), quality of life, healthcare utilization, or cost. The heterogeneity among the studies precluded meta-analysis. Few studies reported the impact of cost sharing strategies on mortality, clinical and economic outcomes. The association between patient copayments and medication adherence varied across studies, ranging from no difference to significantly lower adherence, depending on the amount of the copayment.<h4>Conclusion</h4>Lowering cost sharing in patients with chronic diseases may improve adherence, but the impact on clinical and economic outcomes is uncertain.
format	article
author	Bikaramjit S Mann Lianne Barnieh Karen Tang David J T Campbell Fiona Clement Brenda Hemmelgarn Marcello Tonelli Diane Lorenzetti Braden J Manns
author_facet	Bikaramjit S Mann Lianne Barnieh Karen Tang David J T Campbell Fiona Clement Brenda Hemmelgarn Marcello Tonelli Diane Lorenzetti Braden J Manns
author_sort	Bikaramjit S Mann
title	Association between drug insurance cost sharing strategies and outcomes in patients with chronic diseases: a systematic review.
title_short	Association between drug insurance cost sharing strategies and outcomes in patients with chronic diseases: a systematic review.
title_full	Association between drug insurance cost sharing strategies and outcomes in patients with chronic diseases: a systematic review.
title_fullStr	Association between drug insurance cost sharing strategies and outcomes in patients with chronic diseases: a systematic review.
title_full_unstemmed	Association between drug insurance cost sharing strategies and outcomes in patients with chronic diseases: a systematic review.
title_sort	association between drug insurance cost sharing strategies and outcomes in patients with chronic diseases: a systematic review.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/4c17e3a22b2542f4b3ddb4fe630471c7
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Association between drug insurance cost sharing strategies and outcomes in patients with chronic diseases: a systematic review.

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