Cost-Effectiveness of Medication Therapy Management Program Across Racial and Ethnic Groups Among Medicare Beneficiaries |
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| Institution: | 1. Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA;2. Section of Cancer Economics and Policy, Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA;3. Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA;4. Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA;5. University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA;1. Decision Support and Analysis Staff, Office of Program and Strategic Analysis, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA;2. Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA;3. Erasmus School of Health Policy and Management & Erasmus Choice Modelling Center, Rotterdam, The Netherlands;4. School of Health and Related Research, University of Sheffield, Sheffield, England, UK;5. Global R&D Epidemiology, Janssen R&D, Titusville, NJ, USA;6. Manchester Centre for Health Economics, School of Health Sciences, The University of Manchester, Manchester, England, UK;7. Google, San Francisco, CA, USA;8. Kielo Research, Zug, Switzerland;1. University Hospital of Innsbruck Psychiatry II, Medical University Innsbruck, Innsbruck, Austria;2. Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychosomatic Medicine, Berlin, Germany;3. School of Psychology, University of Sydney, Camperdown, NSW, Australia;4. School of Population Health, Curtin University, Perth, WA, Australia;5. BC Cancer Research Institute, Vancouver, BC, Canada;6. European Organisation for Research and Treatment of Cancer, Brussels, Belgium;7. Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria;8. Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria;1. Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia;2. School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University;3. Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia;4. QIMR Berghofer Medical Research Institute, Herston, QLD, Australia;5. Metro North Mental Health Service, Herston, QLD, Australia;6. Child and Adolescent Mental Health Services Barwon Health, Geelong, VIC, Australia;7. Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia;8. Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia;9. Royal Children’s Hospital, Melbourne, VIC, Australia;10. Murdoch Children’s Research Institute, Melbourne, VIC, Australia;11. Child and Youth Mental Health Service, Eastern Health, Melbourne, VIC, Australia;12. School of Population Health, Curtin University, Perth, WA, Australia;13. Caring Futures Institute, Flinders University, Adelaide, SA, Australia;14. Children’s Health, Queensland Hospital and Health Service, University of Queensland, Herston, QLD, Australia;15. Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology, Sydney, NSW, Australia;1. School of International Business, China Pharmaceutical University, Nanjing, Jiangsu, People’s Republic of China;2. The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, Jiangsu, People’s Republic of China;3. School of Pharmacy, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China;1. Austrian Institute for Health Technology Assessment GmbH, Vienna, Austria;2. Village Research Group, Medical University Innsbruck, Innsbruck, Austria;3. London School of Economics, Care Policy and Evaluation Centre (CPEC), London, England, UK;4. Monash University Australia, School of Rural Health, Melbourne, VIC, Australia;5. Philipps-University Marburg, Fachbereich Psychologie, Marburg, Germany;1. Department of Economics, UNC Greensboro, Greensboro, NC, USA;2. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA;3. RTI International, Chicago, IL, USA;4. Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA |
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| Abstract: | ObjectivesEquity and effectiveness of the medication therapy management (MTM) program in Medicare has been a policy focus since its inception. The objective of this study was to evaluate the cost-effectiveness of the Medicare MTM program in improving medication utilization quality across racial and ethnic groups.MethodsThis study analyzed 2017 Medicare data linked to the Area Health Recourses File. A propensity score was used to match MTM enrollees and nonenrollees, and an incremental cost-effectiveness ratio between the 2 groups was calculated. Effectiveness was measured as the proportion of appropriate medication utilization based on medication utilization measures developed by Pharmacy Quality Alliance. Net monetary benefits were compared across racial and ethnic groups at various societal willingness-to-pay (WTP) thresholds. The 95% confidence intervals were obtained by nonparametric bootstrapping.ResultsMTM dominated non-MTM among the total sample (N = 699 992), as MTM enrollees had lower healthcare costs ($31 135.89 vs $32 696.69) and higher proportions of appropriate medication utilization (87.47% vs 85.31%) than nonenrollees. MTM enrollees had both lower medication costs ($10 681.21 vs $11 003.08) and medical costs ($20 454.68 vs $21 693.61) compared with nonenrollees. The cost-effectiveness of MTM was higher among Black patients than White patients across the WTP thresholds. For instance, at a WTP of $3006 per percentage point increase in effectiveness, the net monetary benefit for Black patients was greater than White patients by $2334.57 (95% confidence interval $1606.53-$3028.85).ConclusionsMTM is cost-effective in improving medication utilization quality among Medicare beneficiaries and can potentially reduce disparities between Black and White patients. Expansion of the current MTM program could maximize these benefits. |
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| Keywords: | cost-effectiveness Medicare medication therapy management medication utilization quality racial and ethnic disparities |
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