UCB Pharma, Allée de la Recherche 60, 1070, Brussels, Belgium.
Appl Health Econ Health Policy. 2013 Aug;11(4):395-406. doi: 10.1007/s40258-013-0033-1.
Parkinson's disease (PD) is a progressive neurological disorder for which, at present, there is no cure. Current therapy is largely based on the use of dopamine agonists and dopamine replacement therapy, designed to control the signs and symptoms of the disease. The majority of current treatments are administered in tablet form and can involve multiple daily doses, which may contribute to sub-optimal compliance. Previous studies with small groups of patients suggest that non-compliance with treatment can result in poor response to therapy and may ultimately increase direct and indirect healthcare costs.
To determine the extent of non-compliance within the general PD population in the USA as well as the patient characteristics and healthcare costs associated with compliance and non-compliance.
A retrospective analysis from a managed care perspective was conducted using data from the USA PharMetrics patient-centric claims database. PharMetrics claims data were complete from 31 December 2005 to 31 December 2009. Patients were included if they had at least two diagnoses for PD between 31 December 2005 and 31 December 2008, were older than 18 years of age, were continuously enrolled for at least 12 months after the date of the most recent PD diagnosis, and had no missing or invalid data. The follow-up period was the most recent 12-month block of continuous enrollment that occurred between 2006 and 2009. Patients were required to have at least one PD-related prescription within the follow-up period. The medication possession ratio (MPR) was used to categorise patients as compliant or non-compliant. Direct all-cause annual healthcare costs for patients with PD were estimated for each patient, and regression analyses were conducted to determine predictors for non-compliance.
A total of 15,846 patients were included, of whom 46 % were considered to be non-compliant with their prescribed medication (MPR <0.8). Predictors of non-compliance included prescription of a medication administered in multiple daily doses (p < 0.0001), a period of <2 years since the initial PD diagnosis (p = 0.0002), a diagnosis of gastrointestinal disorder (p < 0.0001), and a diagnosis of depression (p < 0.0001). Non-compliance was also found to be related to age, with a lower odds of non-compliance in patients aged 41-80 years than in patients aged ≥81 years (p < 0.05). Although total drug mean costs were higher for compliant patients than non-compliant patients (driven mainly by the cost of PD-related medications), the mean costs associated with emergency room and inpatient visits were higher for patients non-compliant with their prescribed medication. Overall, the total all-cause annual healthcare mean cost was lower for compliant ($77,499) than for non-compliant patients ($84,949; p < 0.0001).
Non-compliance is prevalent within the general USA PD population and is associated with a recent PD diagnosis, certain comorbidities, and multiple daily treatment dosing. Non-compliance may increase the burden on the healthcare system because of greater resource usage compared with the compliant population. Treatments that require fewer daily doses may have the potential to improve compliance, which in turn could reduce the economic burden associated with PD.
帕金森病（PD）是一种进行性神经疾病，目前尚无治愈方法。目前的治疗主要基于使用多巴胺激动剂和多巴胺替代疗法，旨在控制疾病的症状和体征。目前大多数治疗方法都是以片剂形式给药，可能需要每天多次服用，这可能会导致治疗依从性不佳。之前对少数患者的研究表明，不遵医嘱可能导致治疗反应不佳，并最终增加直接和间接的医疗保健费用。
确定美国一般 PD 人群中的不遵医行为程度，以及与遵医和不遵医行为相关的患者特征和医疗保健费用。
从管理医疗的角度进行回顾性分析，使用来自美国 PharMetrics 患者中心索赔数据库的数据。 PharMetrics 索赔数据从 2005 年 12 月 31 日至 2009 年 12 月 31 日完整。如果患者在 2005 年 12 月 31 日至 2008 年 12 月 31 日之间至少有两次 PD 诊断，年龄大于 18 岁，在最近一次 PD 诊断后至少连续 12 个月登记，并且没有缺失或无效数据，则符合纳入标准。随访期为 2006 年至 2009 年期间最近的连续登记 12 个月块。患者需要在随访期内至少有一次 PD 相关处方。使用药物使用比例（MPR）将患者分为依从或不依从。估计每位 PD 患者的直接全因年度医疗保健费用，并进行回归分析以确定不依从的预测因素。
共纳入 15846 名患者，其中 46%的患者被认为不遵守处方规定（MPR <0.8）。不依从的预测因素包括每日多次给药的药物处方（p < 0.0001）、初始 PD 诊断后<2 年（p = 0.0002）、胃肠道疾病诊断（p < 0.0001）和抑郁诊断（p < 0.0001）。不依从也与年龄有关，与≥81 岁的患者相比，41-80 岁的患者不遵守医嘱的可能性较低（p < 0.05）。尽管依从患者的总药物平均费用高于不依从患者（主要受 PD 相关药物费用驱动），但不遵守医嘱的患者急诊和住院就诊的平均费用更高。总体而言，依从患者的全因年度医疗保健平均费用低于不依从患者（分别为 77499 美元和 84949 美元；p < 0.0001）。
不依从现象在美国一般 PD 人群中很普遍，与近期 PD 诊断、某些合并症和每日多次治疗剂量有关。与依从人群相比，不依从可能会增加医疗保健系统的负担，因为资源使用量更大。需要每天服用较少剂量的治疗方法可能有潜力提高依从性，从而降低与 PD 相关的经济负担。
