Medicaid Beneficiaries With Congestive Heart Failure: Association of Medication Adherence With Healthcare Use and Costs

Objectives: To examine the association of medication adherence with healthcare use and costs among Medicaid beneficiaries with congestive heart failure (CHF), to investigate whether the association was a graded one, and to estimate the potential savings due to improved adherence. Study Design: Using Medicare and Medicaid data for 4 states, adherence was estimated using the medication possession ratio (MPR). Methods: Multivariate logistic and 2-part general linear models were estimated to study the primary objectives. The MPR was specified in multiple ways to examine its association with healthcare use and costs. Results: Adherent beneficiaries were less likely to have a hospitalization (0.4 percentage points), had fewer hospitalizations (13%), had in excess of 2 fewer inpatient days (25%), were less likely to have an emergency department (ED) visit (3%), and had fewer ED visits (10%) than nonadherent beneficiaries. Total healthcare costs were $5910 (23%) less per year for adherent beneficiaries compared with nonadherent beneficiaries. The relationship between medication adherence and healthcare costs was graded. For example, beneficiaries with adherence rates of 95% or higher had about 15% lower healthcare costs than those with adherence rates between 80% and less than 95% ($17,665 vs $20,747, P<.01). The relationship between adherence and total healthcare costs was even more stark when the most adherent beneficiaries were segmented into finer subgroups. Conclusions: Healthcare costs among Medicaid beneficiaries with CHF would be lower if more patients were adherent to prescribed medication regimens. Researchers should reconsider whether a binary threshold for adherence is sufficient to examine the association of adherence with outcomes and healthcare costs. (Am J Manag Care. 2009;15(7):437-445)