*Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; †Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and ‡Department of Pediatrics, University of Michigan School of Medicine, Ann Arbor, Michigan.
Inflamm Bowel Dis. 2017 Sep;23(9):1577-1583. doi: 10.1097/MIB.0000000000001165.
Nonadherence to treatment recommendations is associated with poorer outcomes in inflammatory bowel disease and may increase the cost of care. We examined the longitudinal relationship between nonadherence and health care costs and hypothesized that at least 3 distinct trajectories of nonadherence would be observed and that increasing nonadherence would account for significantly greater health care costs after controlling for disease activity.
Ninety-nine patients aged 2 to 21 years with inflammatory bowel disease were recruited into this 2-year longitudinal study. Medication possession ratios were calculated from pharmacy refill data, disease activity ratings were obtained from medical charts, and hospital and physician charges associated with an International Classification of Diseases, Ninth Revision code for ulcerative colitis or Crohn's disease were obtained from the hospital's accounting database.
An average total cost effect size of d = 0.68 was observed between the increasing severity and stable low severity groups, but the confidence intervals overlap. Conversely, patients with increasing nonadherence demonstrated significantly higher health care costs than patients with stable ≤10%, stable 11% to 20%, or decreasing nonadherence.
Medication nonadherence is related to increased health care costs after controlling for disease severity. Patients with increasing nonadherence over time demonstrate more than a 3-fold increase in costs compared with adherent patients. In addition, patients whose adherence improves over time incur approximately the same costs as those who are consistently adherent. This suggests that, in addition to leveraging prevention efforts to keep patients from becoming more nonadherent as treatment continues, efforts aimed at modifying adherence behavior may result in significant cost savings over time.
不遵守治疗建议与炎症性肠病的预后较差有关，并且可能增加医疗成本。我们研究了不依从与医疗成本之间的纵向关系，并假设至少可以观察到 3 种不同的不依从轨迹，并且在控制疾病活动后，不依从程度的增加将导致医疗成本显著增加。
这项为期 2 年的纵向研究招募了 99 名年龄在 2 至 21 岁的炎症性肠病患者。从药房补充数据计算药物占有率，从病历获得疾病活动评分，并且从医院的会计数据库中获得与溃疡性结肠炎或克罗恩病国际疾病分类，第九版代码相关的医院和医师费用。
在严重程度逐渐增加和稳定的低严重程度组之间，观察到平均总成本效应大小 d = 0.68，但置信区间重叠。相反，与稳定的≤10％，稳定的 11％至 20％或下降的不依从相比，依从性增加的患者表现出更高的医疗成本。
在控制疾病严重程度后，药物不依从与增加的医疗成本有关。随着时间的推移，依从性逐渐增加的患者的成本增加了 3 倍以上。此外，随着时间的推移依从性提高的患者的成本与始终依从的患者大致相同。这表明，除了利用预防措施防止患者在治疗过程中变得更加不依从之外，旨在改变依从行为的努力可能会随着时间的推移而节省大量成本。
