Tang Jun, Bailey James, Chang Cyril, Faris Richard, Hong Song Hee, Levin Michael, Wang Junling
Health Economics Analyst, Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis.
Professor, College of Medicine, University of Tennessee Health Science Center.
Am Health Drug Benefits. 2016 Nov;9(8):420-429.
Increasingly, third-party payers are requiring patients with multiple sclerosis (MS) to participate in specialty pharmacy management programs to improve their adherence to their prescribed medications. The effects of specialty pharmacy care on MS clinical outcomes have not yet been comprehensively examined in the literature.
To compare the effectiveness of specialty pharmacy care and usual community pharmacy care MS outcomes.
Inpatient, outpatient, and pharmacy claims for patients with MS were extracted from a major national pharmacy benefit management company's databases for this retrospective cohort study. Enrollees with continuous medical and pharmacy benefits were followed for 3 years. MS relapse status was defined by a specific algorithm and was compared in patients who had specialty pharmacy care and those with usual community pharmacy care. The outcome measures included time to the first and second disease relapses and the number of relapses. Kaplan-Meier method and Cox proportional hazards regression analyses were performed on the time to first and second relapses, and generalized linear regression models were performed on the number of disease relapses.
The study cohort included 1731 eligible patients with MS, of whom 1427 received specialty pharmacy care. During the study period, between 2006 and 2009, 1634 relapses were identified, with a mean annual relapse rate of 0.3 among the specialty pharmacy care group versus 0.4 among the usual pharmacy care group. Specialty pharmacy care was associated with a lower risk for disease relapse, with a hazard ratio (HR) of 0.73 (95% confidence interval [CI], 0.607-0.871) for the first relapse and HR of 0.78 (95% CI, 0.610-1.002) for the second relapse. When controlling for demographics, comorbidities, and index medications, specialty pharmacy care was associated with a lower risk for disease relapse with HR of 0.82 (95% CI, 0.680-0.985) for first relapse versus usual pharmacy care. The time to second relapse was not significantly different between the 2 groups in the unadjusted and adjusted Cox regression models. In addition, a generalized linear regression model showed that specialty pharmacy care, index age, geographic North region, 3-year Chronic Disease Score, and Elixhauser comorbidity measure were significantly associated with the number of disease relapses.
These results show that specialty pharmacy care is associated with a significantly lower risk for disease relapse in patients with MS (specifically the first relapse) and fewer relapses compared with usual community pharmacy care.
第三方支付方越来越多地要求多发性硬化症（MS）患者参与专科药房管理项目，以提高他们对处方药物的依从性。专科药房护理对MS临床结局的影响尚未在文献中得到全面研究。
比较专科药房护理和普通社区药房护理对MS结局的有效性。
从一家大型全国性药房福利管理公司的数据库中提取MS患者的住院、门诊和药房索赔数据，用于这项回顾性队列研究。对拥有连续医疗和药房福利的登记者进行了3年的随访。MS复发状态由特定算法定义，并在接受专科药房护理的患者和接受普通社区药房护理的患者中进行比较。结局指标包括首次和第二次疾病复发的时间以及复发次数。对首次和第二次复发的时间进行了Kaplan-Meier法和Cox比例风险回归分析，对疾病复发次数进行了广义线性回归模型分析。
研究队列包括1731名符合条件的MS患者，其中1427名接受了专科药房护理。在研究期间，即2006年至2009年期间，共确定了1634次复发，专科药房护理组的年均复发率为0.3，而普通药房护理组为0.4。专科药房护理与较低的疾病复发风险相关，首次复发的风险比（HR）为0.73（95%置信区间[CI]，0.607 - 0.871），第二次复发的HR为0.78（95%CI，0.610 - 1.002）。在控制人口统计学、合并症和索引药物后，与普通药房护理相比，专科药房护理与较低的疾病复发风险相关，首次复发的HR为0.82（95%CI，0.680 - 0.985）。在未调整和调整后的Cox回归模型中，两组之间第二次复发的时间没有显著差异。此外，广义线性回归模型显示，专科药房护理、索引年龄、地理北部地区、3年慢性病评分和埃利克斯豪泽合并症测量与疾病复发次数显著相关。
这些结果表明，与普通社区药房护理相比，专科药房护理与MS患者疾病复发风险显著降低（特别是首次复发）以及复发次数减少相关。
