Please use this identifier to cite or link to this item: http://hdl.handle.net/10553/52842
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dc.contributor.authorGonzalez, B.en_US
dc.contributor.authorLibrero, J.en_US
dc.contributor.authorPena-Logobardo, L. M.en_US
dc.contributor.authorBauer, S.en_US
dc.contributor.authorGarcia-Sempere, A.en_US
dc.contributor.authorPuig-Junoy, J.en_US
dc.contributor.authorOliva Moreno, J.en_US
dc.contributor.authorPeiro, S.en_US
dc.contributor.authorSanfelix-Gimeno, G.en_US
dc.contributor.otherValcarcel, Bea-
dc.contributor.otherSanfelix-Gimeno, Gabriel-
dc.contributor.otherPeiro, Salvador-
dc.contributor.otherPena Longobardo, Luz Maria-
dc.date.accessioned2019-02-04T13:59:39Z-
dc.date.available2019-02-04T13:59:39Z-
dc.date.issued2016en_US
dc.identifier.issn1098-3015en_US
dc.identifier.urihttp://hdl.handle.net/10553/52842-
dc.description.abstractObjectives: In July 2012, the Spanish drug cost-sharing scheme was reformed, providing the opportunity to evaluate the consequences of this change on patient adherence.The aim of this study was to assess the impact of the cost-sharing change on medication non- adherence in patients with acute coronary syndrome (ACS) in the Spanish region of Valencia. Methods: Population-based retrospective cohort of all patients 35 years old and over discharged after an ACS from public hospitals in the Valencia region during 2009-2011, followed until 2013.We used Difference in Difference to estimate the policy change effect on non-adherence to antiplatelet, beta-blockers, ACEI/ARB and statins of a control group –low income working popula-tion who did not change their status (40% coinsurance, unchanged)- and two inter-vention groups: pensioners (who moved from full coverage to 10% coinsurance) and middle to high income working population, for whom coinsurance grew from 40% to 50% or 60% of drug cost. Results: No significant differences in non-adherence between intervention and control groups were found for medications with low price and low patient maximum coinsurance, such as antiplatelet and beta-blockers. For ACEI/ARB and statins, the policy change had an immediate effect in the propor-tion of non-adherence in the pensioner group as compared with the control group (6.8% and 8.3% increase respectively, p<0.01 for both). Non-adherence to statins significantly increased after the reform for the middle to high income group vs. control group (7.8% increase,p<0.01).However, those effects were transitory (p<0.01 for all medications). Conclusions: Coinsurance changes may lead to increased non-adherence to proven, effective therapies, especially for higher priced agents with higher patient cost share.Adherence was already sub-optimal before the cost-sharing policy change, with a clear cost/income gradient. Consideration should be given to fully exempt high risk patients from drug cost-sharing.en_US
dc.formatapplication/pdf-
dc.languageengen_US
dc.publisher1098-3015-
dc.relation.ispartofValue in Healthen_US
dc.rightsby-nc-nd-
dc.sourceValue In Health [ISSN 1098-3015], v. 19 (7), p. A659en_US
dc.subject531207 Sanidaden_US
dc.subject.otherGasto sanitarioen_US
dc.subject.otherEconomía de la saluden_US
dc.titleEffect of drug cost-sharing change on nonadherence to essential medications for acute coronary syndrome: a population based natural experimenten_US
dc.typeinfo:eu-repo/semantics/Articleen_US
dc.typeArticleen_US
dc.identifier.doi10.1016/j.jval.2016.09.1800en_US
dc.identifier.isi000396606302021-
dcterms.isPartOfValue In Health-
dcterms.sourceValue In Health[ISSN 1098-3015],v. 19 (7), p. A659-A659-
dc.identifier.absysnet729169-
dc.identifier.crisid455-
dc.identifier.eissn1524-4733-
dc.identifier.epageA659-
dc.identifier.issue7-
dc.identifier.spageA659-
dc.identifier.volume19-
dc.investigacionCiencias de la Saluden_US
dc.rights.accessrightsinfo:eu-repo/semantics/openAccess-
dc.type2Artículo preliminaren_US
dc.identifier.wosWOS:000396606302021-
dc.contributor.daisngid28626818-
dc.contributor.daisngid963402-
dc.contributor.daisngid13024958-
dc.contributor.daisngid20943625-
dc.contributor.daisngid4529469-
dc.contributor.daisngid690201-
dc.contributor.daisngid4836229-
dc.contributor.daisngid211348-
dc.contributor.daisngid650724-
dc.identifier.investigatorRIDA-9891-2010-
dc.identifier.investigatorRIDE-9140-2012-
dc.identifier.investigatorRIDH-5778-2017-
dc.identifier.investigatorRIDNo ID-
item.grantfulltextopen-
item.fulltextCon texto completo-
crisitem.author.deptDepartamento de Métodos Cuantitativos en Economía y Gestión-
crisitem.author.deptEconomía de la salud y políticas públicas-
crisitem.author.orcid0000-0002-5571-3257-
crisitem.author.parentorgDepartamento de Métodos Cuantitativos en Economía y Gestión-
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