Columbia Business School, Columbia University, New York, NY, USA.
Faculty of Economics and Business Administration, University of Duisburg-Essen and CINCH - Health Economics Research Center, Campus Essen, Berliner Platz 6-8, 45127, Essen, Germany.
Health Care Manag Sci. 2020 Dec;23(4):605-618. doi: 10.1007/s10729-020-09513-5. Epub 2020 Aug 8.
The annual preventable cost from non-adherence in the US health care system amounts to $100 billion. While the relationship between adherence and the health system, the condition, patient characteristics and socioeconomic factors are established, the role of the heterogeneous productivity of drug treatment remains ambiguous. In this study, we perform cross-sectional retrospective analyses to study whether patients who use newer drugs are more adherent to pharmacotherapy than patients using older drugs within the same therapeutic class, accounting for unobserved heterogeneity at the individual level (e.g. healthy adherer bias). We use US Marketscan commercial claims and encounters data for 2008-2013 on patients initiating therapy for five chronic conditions. Productivity is captured by a drug's earliest Food and Drug Administration (FDA) approval year ("drug vintage") and by FDA" therapeutic potential" designation. We control for situational factors as promotional activity, copayments and distribution channel. A 10-year increase in mean drug vintage is associated with a 2.5 percentage-point increase in adherence. FDA priority status, promotional activity and the share of mail-order prescription fills positively influenced adherence, while co-payments had a negative effect. Newer drugs not only may be more effective in terms of clinical benefits, on average. They provide means to ease drug therapy to increase adherence levels as one component of drug quality, a notion physicians and pharmacy benefit managers should be aware of.
在美国医疗保健系统中，每年因不遵医嘱而产生的可预防费用达到 1000 亿美元。尽管依从性与医疗体系、疾病状况、患者特征和社会经济因素之间的关系已经确立，但药物治疗的异质性生产力的作用仍不明确。在这项研究中，我们进行了横断面回顾性分析，以研究在同一治疗类别中，使用较新药物的患者相对于使用较老药物的患者，在个体水平上（例如，健康依从性偏差）是否具有更高的药物治疗依从性。我们使用了 2008 年至 2013 年美国 Marketscan 商业索赔和就诊数据，对五种慢性疾病开始治疗的患者进行了研究。药物的生产力由其最早的美国食品和药物管理局（FDA）批准年份（“药物年代”）和 FDA“治疗潜力”指定来衡量。我们控制了促销活动、共付额和分销渠道等情境因素。药物年代平均增加 10 年，与依从性增加 2.5 个百分点相关。FDA 优先地位、促销活动和邮购处方的份额对依从性有积极影响，而共付额则有负面影响。较新的药物不仅在临床获益方面平均可能更有效。它们提供了一种手段，可以通过增加药物治疗的便利性来提高依从性水平，这是药物质量的一个组成部分，医生和药品福利管理机构应该意识到这一点。
