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Positive impact of a value-based approach to health care Posted 18/04/2014

A study into the use of value-based benefit design (VBBD) for members of an employee health benefits programme demonstrated that such a programme can have a positive impact on adherence and cost outcomes [1].

A major employer’s healthcare benefits programme was changed on 1 January 2010, to allow members to obtain certain generic diabetic and anti-hyperlipidaemic medications with zero co-payment, provided that the beneficiary participated in a disease management and/or wellness programme.

A retrospective pre- and post-comparison study was carried out by Clark and co-authors to investigate the impact of the VBBD. The study compared existing users of diabetes and hyperlipidaemia medication in the 18-month period prior to the introduction of the VBBD and in the 18 months after implementation of the programme. Existing users were defined as patients that had been using the medication for at least 6 months prior to the 18-month period before the VBBD was introduced. Beneficiaries were included in the study if they were:

(a) continuously enrolled in benefits during the identification, pre-implementation, and post-implementation periods, and
(b) had at least one brand-name or generic medication claim for the treatment of diabetes and/or hyperlipidaemia during the identification and post-implementation periods.

A total of 5,274 users of anti-diabetic medications and 10,355 users of anti-hyperlipidaemic medications met the eligibility criteria for the study. Of the eligible beneficiaries, 891 users of anti-diabetics and 1,449 users of anti-hyperlipidaemics were enrolled into the zero co-payment programme. After matching, using a 1:1 propensity score, for users of anti-diabetics 870 users of the zero co-payment and 870 non-users were included. For users of anti-hyperlipidaemics 1,428 users of the programme and 1,428 non-users were included.

For users of anti-diabetics, the results showed that prior to the introduction of the programme there was no significant difference in adherence to medication between users and non-users of the zero co-payment programme (81.8% vs 81.9%, p = 0.93). However, in the post-introduction period adherence to medication was significantly better in users of the zero co-payment programme compared to non-users (81.9% vs 73.1%, p < 0.001).

For users of anti-hyperlipidaemics, a similar pattern emerged, with no difference in adherence to medication between users and non-users of the zero co-payment programme prior to introduction (77.7% vs 77.6%, p = 0.84). However, after the introduction of the zero co-payment programme, adherence to medication was again significantly better in users of the programme compared to non-users (78.3% vs 70.8%, p < 0.001).

Although the authors admitted that removing the co-payment represents an increased cost to the employer, the reduction in costs due to switching to generics resulted in an overall reduction in costs to the employer of an estimated US$24.00 per member per year.

The authors therefore concluded that this VBBD programme (case management/wellness programme combined with the zero co-payment incentive) had the intended effect of positively impacting adherence to medications used to treat diabetes and high cholesterol for programme participants compared with non-participants without incurring extra costs for the employer.

Conflict of interest
All authors except Rubinstein are paid employees of Walgreens (an American pharmacy chain). Rubinstein is a paid consultant to Walgreens.

Editor’s comment
Readers interested to learn more about patient perspectives on generics substitution are invited to visit www.gabi-journal.net to view the following manuscript published in GaBI Journal:

A review of patient perspectives on generics substitution: what are the challenges for optimal drug use

If you are interested in contributing a research paper in a similar area to GaBI Journal, please send us your submission here.

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1. Clark B, DuChane J, Hou J, Rubinstein E, McMurray J, Duncan I. Evaluation of increased adherence and cost savings of an employer value-based benefits program targeting generic antihyperlipidemic and antidiabetic medications. J Manag Care Pharm. 2014;20(2):141-50.

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