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BMC Gastroenterol. 2012 Sep 24;12:132. doi: 10.1186/1471-230X-12-132.
Observational cohort study to assess the association between adherence to oral 5-aminosalicylates (5-ASAs) and all-cause costs and health care utilization among patients with active ulcerative colitis (UC) in the United States.
Retrospective analysis of insurance claims from June 1997 to August 2006 in the LifeLink Database. Patient criteria: aged 18 or older with one or more claim(s) between June 1997 and August 2005 for a UC diagnosis and at least one oral 5-ASA prescription on or after the first observed UC diagnosis; continuous enrollment for at least 6 months prior to and 12 months following 5-ASA initiation (index date). As a proxy for active disease, patients needed to have at least two UC-specific non-pharmacy claims, at least 30 days of 5-ASA treatment and at least one corticosteroid prescription within the 12-month post-index period. Cumulative exposure to oral 5-ASAs over the 12-month period was calculated using the medication possession ratio (MPR). Patients with an MPR of at least 0.80 were classified as adherent. All-cause medical and pharmacy resource utilization and costs were computed over the 12-month post-index period and compared between adherent and nonadherent patients.
1,693 UC patients met study inclusion criteria: 72% were nonadherent to 5-ASA treatment (n=1,217) and 28% were adherent (n=476) in the 12-month study period. Compared with nonadherent patients, adherent patients had 31% fewer hospitalizations (P=0.0025) and 34% fewer emergency department admissions (P=0.0016). Adherent patients had 25% more pharmacy prescriptions overall (P <0.0001) and 71% more UC-related pharmacy prescriptions (P <0.0001) than did nonadherent patients. Total all-cause health care utilization was 1.13 times higher for adherent patients than for nonadherent patients (P=0.0002). After adjusting for covariates, total all-cause costs were 29% higher for nonadherent patients than for adherent patients (mean [95% confidence interval]: $13,465 [$13,094, $13,835] vs $17,339 [$17,033, $17,645]).
Approximately three-quarters of patients with active UC were not adherent with their prescribed doses of oral 5-ASA. Nonadherence was associated with higher total all-cause costs. The key driver of decreased costs among adherent patients was inpatient hospitalizations, which more than offset these patients' expected higher pharmacy costs.
这是一项在美国进行的观察性队列研究，旨在评估溃疡性结肠炎（UC）患者对口服 5-氨基水杨酸（5-ASA）的依从性与全因成本和医疗保健利用之间的关系。
使用 LifeLink 数据库中 1997 年 6 月至 2006 年 8 月的保险索赔进行回顾性分析。患者标准：年龄在 18 岁或以上，在 1997 年 6 月至 2005 年期间有一个或多个 UC 诊断的索赔，并且在首次观察到 UC 诊断后至少有一个口服 5-ASA 处方；在 5-ASA 起始前至少有 6 个月的连续入组（索引日期）。为了代表活动疾病，患者需要至少有两个 UC 特异性非药房索赔，至少 30 天的 5-ASA 治疗和至少一个皮质类固醇处方在索引后 12 个月内。在 12 个月的治疗期间内，使用药物占有率（MPR）来计算口服 5-ASA 的累积暴露量。MPR 至少为 0.80 的患者被分类为依从性良好。在索引后 12 个月的治疗期间内，计算全因医疗和药房资源的利用情况和成本，并比较依从性和非依从性患者之间的差异。
1693 名 UC 患者符合研究纳入标准：72%的患者（n=1217）对 5-ASA 治疗不依从，28%的患者（n=476）在 12 个月的研究期间内依从。与不依从性患者相比，依从性患者的住院率降低了 31%（P=0.0025），急诊就诊率降低了 34%（P=0.0016）。依从性患者的整体药房处方数量增加了 25%（P<0.0001），UC 相关药房处方数量增加了 71%（P<0.0001）。与不依从性患者相比，依从性患者的全因医疗保健利用率高 1.13 倍（P=0.0002）。调整协变量后，不依从性患者的全因总成本比依从性患者高 29%（平均[95%置信区间]：$13,465 [$13,094, $13,835] vs $17,339 [$17,033, $17,645]）。
大约 3/4 的活动 UC 患者对其口服 5-ASA 的剂量不依从。不依从与全因总成本增加有关。依从性患者成本降低的主要原因是住院治疗，这抵消了这些患者预期的更高药房成本。
