Background: The Medicare Medication Therapy Management (MTM) program has been available since 2006; however, evaluations of its effect on all-cause mortality through comprehensive medication reviews (CMR) are scarce.
Objectives: To study the potential association between MTM through CMR on all-cause mortality among Medicare beneficiaries.
Methods: We conducted a retrospective cohort study to evaluate the effect of receiving a CMR on all-cause mortality. Study data were drawn from a 5% random sample of Medicare beneficiaries, limiting to fee-for-service (FFS) Medicare beneficiaries enrolled in MTM from 1/1/2013 through12/31/2016. We included all beneficiaries aged 65 years or older originally enrolled due to age eligibility and continuously enrolled in the MTM benefit program. Beneficiaries in long-term care facilities were excluded. Exposure was defined as receiving at least 1 CMR after MTM enrollment. Given the lack of information on the lasting effect of receiving a CMR, exposure duration was modeled under different scenarios assuming either constant exposure following the 1st CMR, or a varying duration of effect (12, 9, 6, or 3 months) after the 1st CMR, then unexposed until the next CMR (if any). We used Marginal Structural Models to evaluate the effect of receiving a CMR on all-cause mortality under the different CMR exposure scenarios. Stabilized inverse probability weights (SIPTWs) were estimated based on demographic characteristics, comorbidities, number of active ingredients, and number of potentially inappropriate medications being used.
Results: Our analysis included 95,246 beneficiaries (mean age at baseline 76 (±7) years; 58% females; 92% whites), of which 21,261 (22%) received ≥1 CMR during the study period. On average, follow-up time was 16.9 (±12.6) months, during which 9,411 (9.9%) deaths occurred (11.02% among beneficiaries who never received a CMR vs. 5.92% for those who received at least one CMR). Counterfactual comparisons of a population of beneficiaries with at least one CMR compared to the same population without any CMRs resulted in a lower hazard of mortality from 18% (HR 0.82(0.76-0.89) considering a continuous effect of exposure) up to 32% (HR 0.68(0.59-0.78)) considering 3 months effect of exposure.
Conclusions: Administering CMRs within the scope of the Medicare MTM program to FFS Medicare enrollees was associated with a significantly reduced mortality hazard.
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