Medicaid beneficiaries with congestive heart failure: association of medication adherence with healthcare use and costs

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. Using Medicare and Medicaid data for 4 states, adherence was estimated using the medication possession ratio (MPR). 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. 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