Effect of copayment policies on initial medication non-adherence according to income: a population-based study
Por:
Aznar-Lou, I, Pottegard, A, Fernandez, A, Penarrubia-Maria, MT, Serrano-Blanco, A, Sabes-Figuera, R, Gil-Girbau, M, Fajo-Pascual, M, Moreno-Peral, P, Rubio-Valera, M
Publicada:
1 nov 2018
Resumen:
Objective Copayment policies aim to reduce the burden of medication expenditure but may affect adherence and generate inequities in access to healthcare. The objective was to evaluate the impact of two copayment measures on initial medication non-adherence (IMNA) in several medication groups and by income level.
Design A population-based study was conducted using real-world evidence.
Setting Primary care in Catalonia (Spain) where two separate copayment measures (fixed copayment and coinsurance) were introduced between 2011 and 2013.
Participant Every patient with a new prescription issued between 2011 and 2014 (3 million patients and 10 million prescriptions).
Outcomes IMNA was estimated throughout dispensing and invoicing information. Changes in IMNA prevalence after the introduction of copayment policies (immediate level change and trend changes) were estimated through segmented logistic regression. The regression models were stratified by economic status and medication groups.
Results Before changes to copayment policies, IMNA prevalence remained stable. The introduction of a fixed copayment was followed by a statistically significant increase in IMNA in poor population, low/middle-income pensioners and low-income non-pensioners (OR from 1.047 to 1.370). In high-income populations, there was a large statistically non-significant increase. IMNA decreased in the low-income population after suspension of the fixed copayment and the introduction of a coinsurance policy that granted this population free access to medications (OR=0.676). Penicillins were least affected while analgesics were affected to the greatest extent. IMNA to medications for chronic conditions increased in low/middle-income pensioners.
Conclusion Even nominal charge fixed copayment may generate inequities in access to health services. An anticipation effect and expenses associated with IMNA may have generated short-term costs. A reduction in copayment can protect from non-adherence and have positive, long-term effects. Copayment scenarios could have considerable long-term consequences for health and costs due to increased IMNA in medication for chronic physical conditions.
Filiaciones:
Aznar-Lou, I:
Inst Recerca St Joan de Deu, Res & Dev Unit, Barcelona, Catalonia, Spain
Ctr Invest Biomed Red Epidemiol & Salud Publ, Barcelona, Catalunya, Spain
Pottegard, A:
Univ Southern Denmark, Dept Clin Pharmacol, Odense, Denmark
Fernandez, A:
Ctr Invest Biomed Red Epidemiol & Salud Publ, Barcelona, Catalunya, Spain
Publ Hlth Agcy Barcelona, Serv Community Hlth, Barcelona, Catalonia, Spain
Penarrubia-Maria, MT:
Ctr Invest Biomed Red Epidemiol & Salud Publ, Barcelona, Catalunya, Spain
Inst Catala Salut, Barcelona, Catalunya, Spain
Serrano-Blanco, A:
Ctr Invest Biomed Red Epidemiol & Salud Publ, Barcelona, Catalunya, Spain
Res & Dev Unit, Parc Sanitari St Joan Deu, Barcelona, Catalonia, Spain
Sabes-Figuera, R:
Ctr Invest Biomed Red Epidemiol & Salud Publ, Barcelona, Catalunya, Spain
Univ Pompeu Fabra, Fac Econ & Business Sci, Barcelona, Catalonia, Spain
Gil-Girbau, M:
Primary Care Prevent & Hlth Promot Res Network, Barcelona, Catalonia, Spain
Fajo-Pascual, M:
Univ Zaragoza, Fac Hlth & Sport Sci, Huesca, Spain
Moreno-Peral, P:
Dist Atenc Primaria Malaga Guadalhorce, Malaga, Spain
IBIMA, Malaga, Spain
Rubio-Valera, M:
Inst Recerca St Joan de Deu, Res & Dev Unit, Barcelona, Catalonia, Spain
Ctr Invest Biomed Red Epidemiol & Salud Publ, Barcelona, Catalunya, Spain
Univ Barcelona, Sch Pharm, Barcelona, Catalonia, Spain
Green Submitted
|