接受聚乙二醇化赛妥珠单抗治疗的克罗恩病患者在有或没有家庭健康护士协助情况下的依从率和医疗保健成本：对患者索赔和家庭健康护士数据的回顾性分析结果
Adherence rates and health care costs in Crohn's disease patients receiving certolizumab pegol with and without home health nurse assistance: results from a retrospective analysis of patient claims and home health nurse data.
作者信息
Wolf Douglas C, Jaganathan Srihari, Burudpakdee Chakkarin, Seetasith Arpamas, Low Robert, Lee Edward, Gucky Jay, Yassine Mohamed, Schwartz David A
机构信息
Atlanta Gastroenterology Associates, Atlanta, GA.
UCB Pharma, Smyrna, GA.
出版信息
Patient Prefer Adherence. 2018 May 21;12:869-878. doi: 10.2147/PPA.S148777. eCollection 2018.
BACKGROUND
Patient support programs have a positive effect on adherence to therapy. Certolizumab pegol (CZP) is a tumor necrosis factor antagonist for the treatment of Crohn's disease.
OBJECTIVES
To assess, using real-world claims data, whether home health nurse assistance had an effect on patients' adherence to CZP and to measure its impact on health care use and costs.
METHODS
A retrospective analysis of medical and pharmacy claims data from the IQVIA Real-World Data Adjudicated Claims Database was conducted using data from January 1, 2007 through September 30, 2015. CZP patients with Crohn's disease were eligible to receive self-administration instructions from a nurse or nurse-administered CZP injections, or both. These services were provided by CIMplicity, a home health nurse program sponsored by UCB Pharma. Cohorts were based on patients with and without nurse assistance and were matched based on gender and categorical age. Adherence to CZP was determined using the medication possession ratio (MPR) and proportion of days covered (PDC). A Kaplan-Meier analysis was performed to compare time to discontinuation of CZP between the two cohorts. Multivariate regression analyses were performed, adjusting for additional covariates to compare the effect of CZP with and without nurse assistance on hospitalization and total health care costs.
RESULTS
Patients with at least 12 months of continuous enrollment post-index date were evaluated for adherence to CZP (n=276 in each cohort). The mean and median PDC and MPR values were higher with nurse assistance than without. Time to discontinuation was significantly longer in patients who received CZP with nurse assistance than without (=0.0004). Results from the multivariate analyses showed a significant reduction in all-cause hospitalization (-55.8%; =0.0026) and total health care costs (-14.3%; =0.0045) with nurse assistance.
CONCLUSION
This analysis suggests that home health nurse assistance increases adherence to CZP and reduces health care costs in patients with Crohn's disease.
背景
患者支持项目对治疗依从性有积极影响。赛妥珠单抗（CZP）是一种用于治疗克罗恩病的肿瘤坏死因子拮抗剂。
目的
利用真实世界的索赔数据，评估家庭健康护士协助是否对患者使用CZP的依从性有影响，并衡量其对医疗保健使用和成本的影响。
方法
对IQVIA真实世界数据裁决索赔数据库中2007年1月1日至2015年9月30日的数据进行了医疗和药房索赔数据的回顾性分析。患有克罗恩病的CZP患者有资格接受护士的自我给药指导或护士注射的CZP，或两者皆有。这些服务由优时比制药公司赞助的家庭健康护士项目CIMplicity提供。队列基于有或没有护士协助的患者，并根据性别和分类年龄进行匹配。使用药物持有率（MPR）和覆盖天数比例（PDC）来确定对CZP的依从性。进行了Kaplan-Meier分析，以比较两个队列中停止使用CZP的时间。进行了多变量回归分析，调整了其他协变量，以比较有无护士协助的CZP对住院和总医疗保健成本的影响。
结果
对索引日期后至少连续登记12个月的患者进行了CZP依从性评估（每个队列n = 276）。有护士协助的患者的平均和中位数PDC及MPR值高于没有护士协助的患者。接受有护士协助的CZP治疗的患者的停药时间明显长于没有护士协助的患者（P = 0.0004）。多变量分析结果显示，有护士协助时，全因住院率显著降低（-55.8%；P = 0.0026），总医疗保健成本显著降低（-14.3%；P = 0.0045）。
结论
该分析表明，家庭健康护士协助可提高克罗恩病患者对CZP的依从性并降低医疗保健成本。
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