Yu Yanni F, Nichol Michael B, Yu Andrew P, Ahn Jeonghoon
Department of Pharmaceutical Economics and Policy, University of Southern California, Los Angeles, CA 90089, USA.
Value Health. 2005 Jul-Aug;8(4):495-505. doi: 10.1111/j.1524-4733.2005.00041.x.
To investigate persistence and adherence of medication treatment in chronic overactive bladder/urinary incontinence (OAB/UI) patients, and to evaluate OAB/UI-related comorbidity events associated with persistence.
Pharmaceutical outcomes research with a health-care provider perspective was conducted on a California Medicaid (Medi-Cal) chronic OAB/UI population. The primary end point was medication possession ratio (MPR), which was used to measure refill adherence. Secondary end points measuring persistence patterns included discontinuation of OAB drug therapy (medication-uncovered interval > 30 days) and time to discontinuation (period from the index date until the first discontinuation date). Significant factors on nonpersistence were found by using a Cox Proportional Hazards model. Factors contributing to nonadherence (MPR < 0.8) and the relationship between OAB/UI comorbidity events and persistence were examined by logistic regressions.
Of 2496 eligible patients, 36.9% had only one OAB/UI prescription. The mean MPR was 0.34 (SD 0.21) and the median was 0.3, indicating that on average only about one-third of period of time since medication initiation was covered by the therapy. Only 122 patients exhibited > 80% adherence during the 6-month follow-up-period. Significant predictors of higher persistence included: white ethnicity, previous hospitalization length, starting with tolterodine or oxybutynin extended-release, and previous use of topical drugs or antipsychotics. Nevertheless, previous depression or urinary tract infection (UTI) diagnosis, polypharmacy, significantly increased the odds of early discontinuation. Treatment discontinuation increased the risk of UTI diagnosis by 37% in the post-treatment period (P = 0.03; OR 1.37; 95% CI 1.03-1.84), but had no significant effect on other OAB/UI-related comorbidities.
For chronic OAB/UI patients identified in this study, both persistence and adherence with medication treatment were suboptimal. These results suggest that persistence and treatment discontinuation remains problematic for the OAB/UI population.
调查慢性膀胱过度活动症/尿失禁（OAB/UI）患者药物治疗的持续性和依从性，并评估与持续性相关的OAB/UI合并症事件。
从医疗保健提供者的角度对加利福尼亚医疗补助计划（Medi-Cal）的慢性OAB/UI人群进行药物治疗效果研究。主要终点是药物持有率（MPR），用于衡量再填充依从性。衡量持续性模式的次要终点包括OAB药物治疗的中断（药物未覆盖间隔>30天）和中断时间（从索引日期到首次中断日期的时间段）。使用Cox比例风险模型发现影响非持续性的显著因素。通过逻辑回归分析导致不依从（MPR<0.8）的因素以及OAB/UI合并症事件与持续性之间的关系。
在2496名符合条件的患者中，36.9%仅有一张OAB/UI处方。MPR的平均值为0.34（标准差0.21），中位数为0.3，这表明自开始用药以来，平均只有约三分之一的时间段接受了治疗。在6个月的随访期内，只有122名患者的依从性>80%。持续性较高的显著预测因素包括：白人种族、既往住院时间、起始使用托特罗定或缓释奥昔布宁，以及既往使用局部用药或抗精神病药物。然而，既往有抑郁症或尿路感染（UTI）诊断、联合用药显著增加了早期停药的几率。治疗中断使治疗后UTI诊断的风险增加了37%（P=0.03；OR 1.37；95%CI 1.03-1.84），但对其他与OAB/UI相关的合并症没有显著影响。
对于本研究中确定的慢性OAB/UI患者，药物治疗的持续性和依从性均不理想。这些结果表明，对于OAB/UI人群，持续性和治疗中断仍然是问题。
