Out-of-pocket spending for cardiac rehabilitation and adherence among US adults
Recommended Citation
Mansour AI, Nuliyalu U, Thompson MP, Keteyian S, and Sukul D. Out-of-pocket spending for cardiac rehabilitation and adherence among US adults. Am J Manag Care 2024; 30(12):651-657.
Document Type
Article
Publication Date
12-1-2024
Publication Title
The American journal of managed care
Abstract
OBJECTIVES: Although cardiac rehabilitation (CR) improves cardiovascular outcomes, adherence remains low. Higher patient-incurred out-of-pocket (OOP) spending may be a barrier to CR adherence. We evaluated the association between OOP spending for the first CR session and adherence.
STUDY DESIGN: Retrospective analysis.
METHODS: Commercial and Medicare supplemental beneficiaries with a CR-qualifying event between 2016 and 2020 who attended at least 1 CR session within 6 months of discharge were identified in the MarketScan Commercial Database. OOP spending for the first session was categorized as zero or into 1 of 3 increasing tertiles of OOP spending. Poisson regression was used to determine the association between OOP-spending tertile and CR adherence, defined as the number of CR sessions attended within 6 months of discharge.
RESULTS: A total of 43,992 beneficiaries attended at least 1 CR session. Of these, 35,883 (81.6%) paid $0, 2702 (6.1%) paid $0.01 to $25.39, 2704 (6.1%) paid $25.40 to $82.41, and 2703 (6.1%) paid at least $82.42 for the first session, constituting the first, second, and third OOP-spending tertiles, respectively. Compared with the zero-OOP cohort, the first-tertile cohort attended 13.5% (95% CI, 1.4%-27.1%; P = .028) more CR sessions and the second- and third-tertile cohorts attended 11.9% (95% CI, -16.4% to -7.1%; P < .001) and 30.9% (95% CI, -40.8% to -19.4%; P < .001) fewer CR sessions on average, respectively. For every additional $10 spent OOP on the first CR session, patients attended 0.41 fewer sessions on average (95% CI, -0.65 to -0.17; P < .001).
CONCLUSION: Among patients with OOP spending, higher spending was associated with lower CR adherence, dose dependently. Reducing OOP costs for CR may improve adherence for beneficiaries with cost sharing.
Medical Subject Headings
Humans; Cardiac Rehabilitation; Retrospective Studies; Female; United States; Male; Health Expenditures; Middle Aged; Aged; Adult; Patient Compliance; Medicare
PubMed ID
39745509
Volume
30
Issue
12
First Page
651
Last Page
657
