1. Value of Medication Adherence in Chronic Vascular Disease: Fixed Effects Models of Health Services Utilization and Cost M. Christopher Roebuck Director, Health Economics Co-Authors: Liberman, J.; Gemmill-Toyama, M.; Brennan, T. American Society of Health Economists 3 rd Biennial Conference Cornell University, Ithaca, NY Monday, June 21, 2010 8:30-10:00am (Hollister 306)

8. MPR Histograms Congestive Heart Failure Hypertension Diabetes Dyslipidemia

9. Exploring Functional Form of MPR->Total Healthcare Costs

12. Sample Means Variable CHF Hypertension Diabetes Dyslipidemia Male 0.550 0.487 0.532 0.502 Age 77.301 68.401 67.872 65.096 Senior (Age ≥ 65) 0.872 0.614 0.615 0.517 Charlson Comorbidity Index 2.025 1.112 1.696 1.001 Annual Inpatient Hospital Days 11.901 3.291 4.255 2.239 Annual Emergency Dept Visits 0.613 0.318 0.353 0.265 Annual Outpatient Physician Visits 11.651 8.506 9.407 8.660 Annual Pharmacy Costs $3,780 $2,867 $3,624 $2,920 Annual Medical Costs $39,076 $14,813 $17,955 $12,688 Annual Total Healthcare Costs $42,856 $17,680 $21,580 $15,608 Medication Possession Ratio (MPR) 0.400 0.591 0.513 0.522 Optimally Adherent (MPR ≥ 0.80) 0.340 0.505 0.412 0.426

13. Bivariate Results: Health Services Utilization and Cost by Medication Adherence Status Condition Adherence Status Inpatient Hospital Days Emergency Department Visits Outpatient Physician Visits Pharmacy Costs Medical Costs Total Healthcare Costs CHF Non-adherent 13.220 0.648 11.344 $3,274 $42,549 $45,823 Adherent 8.046 0.569 14.339 $4,649 $33,113 $37,762 Hypertension Non-adherent 4.245 0.372 8.690 $2,171 $16,835 $19,006 Adherent 1.613 0.256 8.708 $3,251 $11,041 $14,292 Diabetes Non-adherent 4.695 0.372 9.236 $2,615 $18,501 $21,116 Adherent 2.520 0.313 10.228 $4,586 $14,725 $19,311 Dyslipidemia Non-adherent 2.055 0.258 8.137 $1,932 $10,880 $12,812 Adherent 1.621 0.248 9.616 $3,850 $12,479 $16,329

14. Fixed Effects Results: Impatient Hospital Days Notes: Presented are marginal effect estimates from linear fixed effects models of health services utilization. All models included a weighted Charlson Comorbidity Index; two year indicator variables; dummy variables for senior, male, and adherent; and interaction terms for adherent with male and senior. Statistical significance based on robust Driscoll-Kraay standard errors denoted as follows: *** p<0.01; ** p<0.05; * p<0.10. Table 4. Estimated Effects of Medication Adherence on Annual Health Services Utilization by Chronic Vascular Condition Health Services Utilization Category Adherence Comparison Congestive Heart Failure (n = 16,353) Hypertension (n = 112,757) Diabetes (n = 42,080) Dyslipidemia (n = 53,041) Annual inpatient hospital days Adherent (vs. non-adherent) -5.715*** -2.135*** -2.394*** -1.177*** Adherent female (vs. non-adherent female) -6.461*** -2.218*** -2.376*** -1.145*** Adherent male (vs. non-adherent male) -5.114*** -2.046*** -2.410*** -1.209*** Adherent senior (vs. non-adherent senior) -5.868*** -3.143*** -3.407*** -1.881*** Adherent non-senior (vs. non-adherent non-senior) -4.737*** -0.572*** -0.834*** -0.442***