Armstrong Edward P, Malone Daniel C, Krishnan Sangeeta, Wessler Maj Jacob
Hematology. 2015 Apr;20(3):148-53. doi: 10.1179/1607845414Y.0000000176. Epub 2014 Jul 7.
Evaluate adherence to clotting factor treatment and associated outcomes for patients with hemophilia using an integrated delivery database.
This was a retrospective, observational study tracking patients between 2006 and 2011. Patients with diagnosis codes for hemophilia were identified. Bleeding and complication rates were annualized over the study period. Medication adherence was assessed using prescription claims for clotting factors by examining sequential time periods of 180 days for each patient's continuous enrollment. Adherence within the time period was calculated using the 'days supply' field divided by 180 days. Under the assumption that severe patients should be treated prophylactically, patients were considered adherent within the time period if the ratio of 'days supply' to observed days was 60% or greater.
A total of 207 patients (74.9 and 25.1% hemophilia A and B, respectively) met the inclusion/exclusion criteria. There were 101 (48.8%) mild, 32 (15.5%) moderate, and 74 (35.7%) severe patients with hemophilia. The percentage of time periods where adherence to clotting factors was 60% or greater was 14% (SD = 28%) for mild disease, 21% (SD = 32%) for moderate disease, and 51% (SD = 36%) for severe disease. Among patients with severe disease, 27 (36.5%) were adherent ≤ 30% of time periods, 22 (29.7%) adherent 31-70% of the time periods, and 25 (33.8%) were adherent ≥ 71% of time periods. Joint bleeding episodes and hospitalizations were uncommon events among the three groups.
Among patients with severe disease, the majority (66.2%) were adherent <70% of the time.
利用综合医疗数据库评估血友病患者对凝血因子治疗的依从性及相关结局。
这是一项回顾性观察研究，追踪2006年至2011年期间的患者。确定患有血友病诊断编码的患者。在研究期间对出血率和并发症发生率进行年化处理。通过检查每位患者连续参保的180天连续时间段内的凝血因子处方申请来评估药物依从性。使用“供应天数”字段除以180天来计算该时间段内的依从性。假设重度患者应接受预防性治疗，如果“供应天数”与观察天数的比率为60%或更高，则认为患者在该时间段内依从。
共有207例患者（分别为74.9%的A型血友病和25.1%的B型血友病）符合纳入/排除标准。有101例（48.8%）轻度、32例（15.5%）中度和74例（35.7%）重度血友病患者。轻度疾病患者凝血因子依从性达到60%或更高的时间段百分比为14%（标准差=28%），中度疾病为21%（标准差=32%），重度疾病为51%（标准差=36%）。在重度疾病患者中，27例（36.5%）在≤30%的时间段内依从，22例（29.7%）在31%-至70%的时间段内依从，25例（33.8%）在≥71%的时间段内依从。三组中关节出血发作和住院均为罕见事件。
在重度疾病患者中，大多数（66.2%）在不到70%的时间内依从。
