Cantrell Christopher Ron, Eaddy Michael T, Shah Manan B, Regan Timothy S, Sokol Michael C
GlaxoSmithKline, Research Triangle Park, North Carolina, USA.
Med Care. 2006 Apr;44(4):300-3. doi: 10.1097/01.mlr.0000204287.82701.9b.
The objective of this study was to differentiate between 3 measures of antidepressant adherence with regard to the number of patients deemed adherent to therapy and the association between adherence and resource utilization.
The authors conducted a retrospective study of patients initiating selective serotonin reuptake inhibitor (SSRI) therapy for depression and/or anxiety between July 2001 and June 2002 in a large national managed care database.
Rates of 6-month SSRI adherence were measured by 3 different metrics: length of therapy (LOT), medication possession ratio (MPR), and combined MPR/LOT. Differences in resource utilization for each adherence metric were measured for patients deemed as 1) adherent, 2) nonadherent, 3) therapy changers, and 4) dose titraters.
There were 22,947 patients meeting study criteria. Although statistically different, 6-month adherence rates were numerically similar across all methods (LOT, 44.6%; MPR, 43.3%; and MPR/LOT, 42.9%, P < 0.001); approximately 57% of patients were nonadherent to therapy. Regardless of metric, the adherent cohort incurred the lowest yearly medical costs, followed by the nonadherent, titrate, and therapy change cohorts (P < 0.001 between adherent cohort and all other cohorts). The LOT method produced the greatest difference in yearly medical costs between adherent and nonadherent patients (Dollars 511) followed by MPR/LOT (Dollars 432) and MPR (Dollars 423). When antidepressant prescription costs were added to medical costs, patients requiring a therapy change and titrating therapy incurred higher costs than adherent patients, whereas nonadherent and adherent patients incurred similar costs.
Regardless of adherence metric, approximately 43% of patients were adherent to antidepressant therapy, and adherent patients were associated with the lowest yearly medical costs.
本研究的目的是在被视为坚持治疗的患者数量以及坚持治疗与资源利用之间的关联方面，区分三种抗抑郁药依从性的衡量方法。
作者在一个大型全国性管理式医疗数据库中，对2001年7月至2002年6月期间开始使用选择性5-羟色胺再摄取抑制剂（SSRI）治疗抑郁症和/或焦虑症的患者进行了一项回顾性研究。
通过三种不同指标衡量6个月的SSRI依从率：治疗时长（LOT）、药物持有率（MPR）以及综合MPR/LOT。针对被视为1）坚持治疗、2）不坚持治疗、3）更换治疗方案者和4）调整剂量者的患者，测量了每种依从性指标在资源利用方面的差异。
有22947名患者符合研究标准。尽管在统计学上存在差异，但所有方法的6个月依从率在数值上相似（LOT为44.6%；MPR为43.3%；MPR/LOT为42.9%，P<0.001）；约57%的患者未坚持治疗。无论采用何种指标，坚持治疗的队列每年的医疗费用最低，其次是不坚持治疗、调整剂量和更换治疗方案的队列（坚持治疗队列与所有其他队列之间P<0.001）。LOT方法在坚持治疗和不坚持治疗患者之间产生的年度医疗费用差异最大（511美元），其次是MPR/LOT（432美元）和MPR（423美元）。当将抗抑郁药处方费用加入医疗费用时，需要更换治疗方案和调整治疗剂量的患者产生的费用高于坚持治疗患者，而不坚持治疗和坚持治疗的患者产生的费用相似。
无论依从性指标如何，约43%的患者坚持抗抑郁治疗，且坚持治疗的患者每年的医疗费用最低。
