From the Health Services Research Program, Department of Neurology (E.L.R., J.F.B., K.A.K., L.E.S., B.C.C.), and School of Public Health (M.B.), University of Michigan; Veterans Affairs Healthcare System (J.F.B., B.C.C.), Ann Arbor, MI; American Academy of Neurology (B.M.), Minneapolis, MN; and the Department of Neurology (G.J.E.), Emory University, Atlanta, GA.
Neurology. 2020 Mar 31;94(13):e1415-e1426. doi: 10.1212/WNL.0000000000009039. Epub 2020 Feb 19.
To determine the association between out-of-pocket costs and medication adherence in 3 common neurologic diseases.
Utilizing privately insured claims from 2001 to 2016, we identified patients with incident neuropathy, dementia, or Parkinson disease (PD). We selected patients who were prescribed medications with similar efficacy and tolerability, but differential out-of-pocket costs (neuropathy with gabapentinoids or mixed serotonin/norepinephrine reuptake inhibitors [SNRIs], dementia with cholinesterase inhibitors, PD with dopamine agonists). Medication adherence was defined as the number of days supplied in the first 6 months. Instrumental variable analysis was used to estimate the association of out-of-pocket costs and other patient factors on medication adherence.
We identified 52,249 patients with neuropathy on gabapentinoids, 5,246 patients with neuropathy on SNRIs, 19,820 patients with dementia on cholinesterase inhibitors, and 3,130 patients with PD on dopamine agonists. Increasing out-of-pocket costs by $50 was associated with significantly lower medication adherence for patients with neuropathy on gabapentinoids (adjusted incidence rate ratio [IRR] 0.91, 0.89-0.93) and dementia (adjusted IRR 0.88, 0.86-0.91). Increased out-of-pocket costs for patients with neuropathy on SNRIs (adjusted IRR 0.97, 0.88-1.08) and patients with PD (adjusted IRR 0.90, 0.81-1.00) were not significantly associated with medication adherence. Minority populations had lower adherence with gabapentinoids and cholinesterase inhibitors compared to white patients.
Higher out-of-pocket costs were associated with lower medication adherence in 3 common neurologic conditions. When prescribing medications, physicians should consider these costs in order to increase adherence, especially as out-of-pocket costs continue to rise. Racial/ethnic disparities were also observed; therefore, minority populations should receive additional focus in future intervention efforts to improve adherence.
确定在 3 种常见神经疾病中外付费用与药物依从性之间的关联。
我们利用 2001 年至 2016 年的私人保险理赔数据，确定了患有神经病变、痴呆或帕金森病（PD）的患者。我们选择了开具有相似疗效和耐受性但外付费用不同的药物的患者（神经病变患者用加巴喷丁类药物或混合 5-羟色胺/去甲肾上腺素再摄取抑制剂 [SNRIs]，痴呆患者用胆碱酯酶抑制剂，PD 患者用多巴胺激动剂）。药物依从性定义为前 6 个月供应的天数。采用工具变量分析来估计外付费用和其他患者因素对药物依从性的关联。
我们确定了 52249 名使用加巴喷丁类药物治疗神经病变的患者、5246 名使用 SNRIs 治疗神经病变的患者、19820 名使用胆碱酯酶抑制剂治疗痴呆的患者和 3130 名使用多巴胺激动剂治疗 PD 的患者。外付费用每增加 50 美元，使用加巴喷丁类药物治疗神经病变的患者（调整后的发生率比 [IRR]0.91，0.89-0.93）和痴呆患者（调整后的 IRR0.88，0.86-0.91）的药物依从性显著降低。使用 SNRIs 治疗神经病变的患者（调整后的 IRR0.97，0.88-1.08）和使用 PD 治疗的患者（调整后的 IRR0.90，0.81-1.00）的外付费用增加与药物依从性无显著关联。与白人患者相比，少数民族患者使用加巴喷丁类药物和胆碱酯酶抑制剂的依从性较低。
在 3 种常见神经疾病中，较高的外付费用与较低的药物依从性相关。在开具药物时，医生应考虑这些费用，以提高依从性，尤其是在外付费用继续上升的情况下。还观察到种族/民族差异；因此，在未来的干预努力中，应特别关注少数民族人群，以提高他们的依从性。
