PP46 A cross country comparison of the effect of co-payments for prescriptions on adherence to medications
Notice bibliographique
Résumé
Background Generalisability has been reported as a barrier to using evidence in policy making. Little data are available on whether US and Canadian based evidence on cost-sharing and medication adherence is generalizable to international populations. To explore external validity, we compared the impact of two similar cost sharing policies, one in the US and one in Ireland, on medication adherence. Methods A repeated measures longitudinal study design was employed to measure individual drug adherence before and after the introduction of drug cost-sharing policies. The Irish policy introduced a 50 cent copayment/prescription item in a publicly insured population in 2010. A similar policy occurred in the Massachusetts Medicaid population in 2003. Prescription data were obtained from centrally held pharmacy claims databases; HSE-PCRS, in Ireland and Medicaid Analytical Extract in the US New users of anti-hypertensive, anti-hyperlipidaemic and anti-diabetes drugs entered the cohort 6 months prior to initiation of cost-sharing polices and were followed for 12 months post-policy change. Segmented regression with generalised estimating equations and an autoregressive correlation structure was used. Results The Irish policy change resulted in a 3.9% (95% CI, 2.91%-5.02%) immediate drop in adherence to anti-hypertensive drugs in Ireland, whereas the US policy did not affect anti-hypertensive adherence. Relative to the US, the Irish population had a 5.3% (95% CI, 3.68% - 6.92%) additional decrease in adherence to anti-hypertensive drugs immediately after the policy change. Adherence to anti-hyperlipidaemic drugs was insignificantly reduced (-0.6235%, 95% CI, - 2.41%-1.16%) immediately post-policy change in the U. S. However, adherence to anti-hyperlipidaemics was reduced in Ireland by 3.4% (95% CI, 2.25%-4.62%). Compared to the US, Irish patients decreased their adherence to anti-hyperlipidaemics by 2.8% (95% CI, 0.673%-4.945%). Adherence to anti-diabetic drugs did not differ internationally post-policy change. There was no evidence for international differences in the long-term impact (12 months) of policy changes. Conclusion Irish and US populations had different changes in adherence to anti-hypertensive and anti-hyperlipidaemic drugs directly after implementation of cost-sharing policies, with greater reductions in adherence in the Irish population. However, changes in adherence to anti-diabetic drugs were similar between the populations. This study suggests that North American and Canadian evidence may not be automatically internationally generalizable. Rather, the specific attributes of a setting should always be considered before applying evidence to policy. This novel study will be of interest to global policymakers as they seek to develop evidence based cost-sharing policies.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,014 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,004 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,009 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».