多发性硬化症中干扰素β的持续使用、依从性、医疗资源利用和成本：坎帕尼亚地区（意大利南部）的一项基于人群的研究。
Persistence, adherence, healthcare resource utilisation and costs for interferon Beta in multiple sclerosis: a population-based study in the Campania region (southern Italy).
机构信息
Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Via Sergio Pansini 5, Building 17, Ground floor, 80131, Naples, Italy.
Department of Public Health, Federico II University, Naples, Italy.
出版信息
BMC Health Serv Res. 2020 Aug 26;20(1):797. doi: 10.1186/s12913-020-05664-x.
BACKGROUND
To differentiate five formulations of Interferon Beta for the treatment of multiple sclerosis (MS) in clinical practice, by analysing persistence, adherence, healthcare resource utilisation and costs at population level.
METHODS
In this population-based study, we included individuals with MS living in the Campania Region of Italy from 2015 to 2017, on treatment with intramuscular Interferon Beta-1a (Avonex® = 618), subcutaneous pegylated Interferon Beta-1a (Plegridy® = 259), subcutaneous Interferon Beta-1a (Rebif® = 1220), and subcutaneous Interferon Beta-1b (Betaferon® = 348; and Extavia® = 69). We recorded healthcare resource utilisation from administrative databases (hospital discharges, drug prescriptions, MS-related outpatients), and derived costs from the Regional formulary. We classified hospital admissions into MS-related and non-MS-related. Persistence (time to switch to other disease modifying treatments (DMTs)), and adherence (medication possession ratio (MPR) = medication supply obtained/medication supply expected during follow-up period) were calculated.
RESULTS
Patients treated with Rebif® were younger, when compared with other Interferon Beta formulations (p < 0.01). The probability of switching to other DMTs was 60% higher for Betaferon®, 90% higher for Extavia®, and 110% higher for Plegridy®, when compared with Rebif® (p < 0.01). Plegridy® presented with 7% higher adherence (p < 0.01), and Betaferon® with 3% lower adherence (p = 0.03), when compared with Rebif®. The probability of MS-related hospital admissions was 40% higher in Avonex® (p = 0.03), 400% higher in Betaferon® (p < 0.01), and 60% higher in Plegridy® (p = 0.04), resulting into higher non-DMT-related costs, when compared with Rebif®.
DISCUSSION
Interferon Beta formulations presented with different prescription patterns, persistence, adherence, healthcare resource utilisation and costs, with Rebif® being used in younger patients and with less MS-related hospital admissions.
背景
为了在临床实践中区分五种用于治疗多发性硬化症（MS）的干扰素β制剂，我们对人群水平的药物持久性、依从性、医疗资源利用和成本进行了分析。
方法
在这项基于人群的研究中，我们纳入了 2015 年至 2017 年在意大利坎帕尼亚地区接受肌内注射干扰素β-1a（Avonex®=618 例）、皮下聚乙二醇干扰素β-1a（Plegridy®=259 例）、皮下干扰素β-1a（Rebif®=1220 例）和皮下干扰素β-1b（Betaferon®=348 例；和 Extavia®=69 例）治疗的 MS 患者。我们从行政数据库（住院记录、药物处方、MS 相关门诊）中记录了医疗资源的使用情况，并从地区处方中获得了成本数据。我们将住院治疗分为 MS 相关和非 MS 相关。计算了药物的持久性（从转换为其他疾病修正治疗（DMT）的时间）和依从性（药物使用比例（MPR）=实际获得的药物供应/随访期间预期的药物供应）。
结果
与其他干扰素β制剂相比，接受 Rebif®治疗的患者更年轻（p<0.01）。与 Rebif®相比，Betaferon®的转换概率增加了 60%，Extavia®增加了 90%，Plegridy®增加了 110%（p<0.01）。与 Rebif®相比，Plegridy®的依从性增加了 7%（p<0.01），而 Betaferon®的依从性下降了 3%（p=0.03）。与 Rebif®相比，Avonex®的 MS 相关住院治疗概率增加了 40%（p=0.03），Betaferon®增加了 400%（p<0.01），Plegridy®增加了 60%（p=0.04），从而导致与 Rebif®相比，非 DMT 相关的费用增加。
讨论
干扰素β制剂的处方模式、持久性、依从性、医疗资源利用和成本存在差异，Rebif®用于治疗年轻患者，且 MS 相关住院治疗的患者较少。
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