Congestive Heart Failure Study for the Pharmaceutical Industry
The objective of this engagement was to examine the potential effects of prescription drug coverage among elderly persons with Congestive Heart Failure (CHF) within selected Medicare beneficiary populations and on total Medicare program expenditures. The data source for this study was the 2002 Medicare Current Beneficiary Survey (MCBS) conducted by the Centers for Medicaid and Medicare Services (CMS).
CHF patients were identified in the MCBS dataset and classified into those with and without prescription drug benefits. Patients with drug benefits were classified into groups with low, medium, and high compliance to CHF drug therapy protocols.
Primary analyses of data included examination of patient characteristics, compliance with medication, incidence of hospitalization, and resource utilization and both out-of-pocket and payer costs. Comparisons between groups (i.e., by presence of drug benefit as well as by compliance level) were first made descriptively, based on overall group means and percentages. Differences were evaluated based on appropriate descriptive statistics (chi-squares or Fisher’s Exact Test for proportions, and analysis of variance [ANOVA] for continuous variables).
The primary clinical outcome of interest was the re-hospitalization rate during the one-year observation period. Hospital admissions with related principal diagnosis were considered for this measure; this rate was compared between patients without a drug benefit and those with such a benefit (stratified by compliance level). Other resources tracked included pharmacy claim activity, emergency-room, physician office, and other outpatient visits, ancillary claims, and hospitalizations for other reasons (i.e., principal diagnoses other than CHF).
Total out-of-pocket expenditures for patients (e.g., co-payment, coinsurance, deductibles) for all services rendered and medications received during the one-year follow-up period was assessed and again compared between the three groups described above. Finally, total costs of care for the services and medications was assessed and compared based on reimbursed amounts from the claims submitted.