Approximately 23.6 million people in the US have diabetes, and two out of three will die from either stroke or heart disease. Control of metabolic risk factors such as blood pressure and cholesterol is an important part of prevention for these patients. Although medication can help reduce the risk of adverse events, many patients take less than the prescribed dose of their medications, likely due to the burdens of treatment. The proposed research for this dissertation grant will first study the effects of poor adherence on blood pressure and cholesterol levels. It will establish the relationship between variation in patient adherence to medication and cholesterol and blood pressure levels. Simultaneously, a treatment model will be developed to determine the optimal treatment plan for managing blood pressure and cholesterol levels assuming perfect adherence to treatment and measure the potential improvements over existing guidelines. This treatment model will consider the tradeoff between cost of treatment and effects on quality of life, in terms of the burden of taking medications and the potential for preventing adverse events. Results from the treatment model will be generated from both, the patient (QALYs) and the third party payer (cost) perspective, as well as a society perspective combining the goals of improving quality of life and minimizing costs. The results from the adherence portion of the study will help inform decision makers about if and how to implement adherence improving interventions for patients with less than perfect adherence. The treatment and adherence models will be integrated to study the influence of less than perfect adherence on treatment decisions, and to evaluate the cost effectiveness of interventions that improve adherence. The integrated model will be able to answer many questions about treatment that are relevant to patients, physicians, and policy makers. For instance, what influence do gender and ethnicity have on optimal treatment decisions, and for patients in need of treatment, which risk factor and type of treatment is the highest priority? How inexpensive do interventions need to be in order for implementation to be feasible? When is the best time for adherence interventions? While this proposed research is specific to treatment of diabetes patients, the research has potential to be extended to other types of chronic diseases.
This project involves the development of quantitative models to evaluate the comparative effectiveness of current treatment guidelines for cholesterol and blood pressure control in patients with type 2 diabetes. It will result in findings about the influence of gender and ethnicity on optimal treatment guidelines, how to prioritize treatment options, and if or when to hold adherence improving interventions.
