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FIGURE 7: Diabetes: An

FIGURE 7: Diabetes: An Example of Underdiagnosis and Undertreatment Uncontrolled diabetes can lead to kidney failure, amputation, blindness, and stroke. PREVALENCE 30 million Americans have DIABETES DIAGNOSIS 23 million are DIAGNOSED 7 million are UNDIAGNOSED 19 million are TREATED 4 million are UNTREATED TREATMENT* 8 million are SUCCESSFULLY TREATED 11 million are UNSUCCESSFULLY TREATED CONTROL 8 million have CONTROLLED DIABETES 22 million have UNCONTROLLED DIABETES *Treatment includes blood sugar control (medicines, diet, and exercise) and testing to prevent complications. Data rounded to whole numbers. Source: *Treatment IHS Life includes Sciences blood analysis sugar based control Centers (medicines, for Disease diet, Control and and exercise) Prevention and data. testing National to prevent Health and complications. Nutrition Examination Survey, 2013-2014. search/nhanes13_14.aspx. Data rounded to whole Accessed numbers. April 2016. within 3 months after being initially prescribed the controller medication relative to children with better adherence. 14 • Diabetes: For many patients, successful management of diabetes requires constant and diligent monitoring, multiple daily injections, coordination of multiple oral medicines, and a carefully planned daily routine to avoid serious complications. This challenge underscores the importance of medicines that reduce burdens to patients and improve adherence (see Figure 7). Among diabetes patients, adherence is associated with fewer emergency department visits and lower rates of complications, including heart attack, amputation, and vision impairment/blindness (retinopathy). 15 • Cystic Fibrosis (CF): CF is a life-threatening rare disease primarily affecting the lungs and digestive system. Research shows more than twice as many patients who were poorly adherent to pulmonary medications for their condition experienced a pulmonary embolism relative to those with good adherence. 16 Poor adherence to pulmonary medications has also been shown to be associated with higher use of acute health care services. Patients with low adherence were hospitalized 35% more often than those with high adherence. 17 22 Improving Health Outcomes and Driving Value in Health Care

THE ECONOMIC VALUE OF BETTER USE OF MEDICINES The appropriate use of medicine can keep patients healthy and reduce the need for medical services—saving money for both patients and the nation’s health care system. 18,19,20 Likewise, inappropriate use of medicines can result in unnecessary medical care, increased health care costs, and poor patient outcomes. For example, misuse and abuse of prescription medicines results in unnecessary use of health care services, increased hospitalizations, and greater health care costs. Evidence suggests that inappropriate use— such as poor medication adherence, suboptimal prescribing, and medication errors—result in an estimated $213 billion in avoidable health care costs each year, representing 8% of the nation’s health care spending and providing an opportunity to produce substantial savings for the health system at large. 21 Improved use of medicines increases prescription drug spending, but these costs are often offset by reductions in other health care spending. Due to a growing body of evidence, in 2012 the Congressional Budget Office (CBO) revised its methodology for estimating the federal budget impact of policy changes to recognize reductions in other medical expenditures associated with increased use of prescription medicines in Medicare. 22 Since the CBO announcement, the evidence has continued to develop and grow, broadening the potential cost offsets attributed to use of medicines. In fact, a recent study suggests the savings due to better use of medicines in Medicare may be 3 to 6 times greater than estimated by CBO in 4 common chronic conditions—heart failure, diabetes, hypertension, and high cholesterol. 23 New evidence also suggests increased use of medicines is associated with reductions in expenditures from avoided use of inpatient and outpatient services in the Medicaid population. 24 In addition to producing savings from avoided health care costs, better use of medicines also improves health and overall quality of life, which can lead to improved productivity through reduced absenteeism and use of disability leave. Improvements in worker productivity also yield important contributions to the economy at large. Several examples across a range of conditions illustrate the savings realized by patients and the health care system as a result of better use of Improving Health Outcomes and Driving Value in Health Care 23

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