分析巴基斯坦癫痫患者的治疗依从性和成本：一项为期四年的回顾性队列研究。
Analysis of treatment adherence and cost among patients with epilepsy: a four-year retrospective cohort study in Pakistan.
机构信息
Department of Pharmaceutics, Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University Karachi, Karachi, Pakistan.
Department of Pharmacology, Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University Karachi, Karachi, Pakistan.
出版信息
BMC Health Serv Res. 2021 Jan 19;21(1):72. doi: 10.1186/s12913-021-06085-0.
BACKGROUND
The adherence pattern of antiepileptic drugs (AEDs) among patients with epilepsy is relatively lower in the United States and different European countries. However, adherence and cost analysis of AEDs in Asian countries have not been thoroughly studied. Therefore, the present study aimed to analyze the cost and adherence of AEDs and its associated factors in patients followed in Pakistan.
METHODS
Data from prescriptions collected from patients with epilepsy who have visited the Outpatient Department (OPD) of different tertiary care hospitals at the cosmopolitan city of Karachi, Pakistan from December 2015 to November 2019. The mean follow-up period for each participant was about 22 months. Pairwise comparisons from Cox regression/hazard ratios were used to assess the predictors of adherence. Direct costs of AEDs were calculated and presented as the annual cost of drugs.
RESULTS
A total of 11,490 patients were included in this study, 51.2 % were male and 48.8 % were female with a mean age of 45.2 ± 15.8 y. Levetiracetam was found as the most prescribing AED in all study participants (32.9 %). Of them, 49.1 % of patients continued their initial recommended treatment. However, 31.3 % of patients have discontinued the therapy, while, 19.6 % were switched to other AED. Adherence with initial treatment was more profound in male (57.4 %) patients, compared to female with a mean age of 44.2 years. Lamotrigine users (60.6 %) showed a higher tendency to retain on initially prescribed drugs. The total cost of epilepsy treatment in the entire study cohort was 153280.5 PKR ($941.9). By applying the Cox regression analysis, it can be observed that the patients with increasing age (OR, 2.04), migraine (OR, 2.21), psychiatric disorders (OR, 4.28), other comorbidities (OR, 1.52) and users of other than top five prescribing AEDs (2.35) were at higher risk of treatment discontinuation. However, levetiracetam (OR, 0.69), valproic acid (OR, 0.52), carbamazepine (OR, 0.81), lamotrigine (OR, 0.80) or lacosamide (OR, 0.65) users have more chances to continue their initial therapy.
CONCLUSIONS
Similar to western countries, the majority of patients with epilepsy exhibited low adherence with AEDs. Various associated factors for improving adherence were identified in this study.
背景
在美国和一些欧洲国家，癫痫患者的抗癫痫药物（AED）依从性相对较低。然而，亚洲国家 AED 的使用和成本分析尚未得到充分研究。因此，本研究旨在分析巴基斯坦患者 AED 的使用和成本及其相关因素。
方法
从 2015 年 12 月至 2019 年 11 月在巴基斯坦卡拉奇市不同三级医院的门诊就诊的癫痫患者的处方中收集数据。每位参与者的平均随访时间约为 22 个月。使用 Cox 回归/风险比的成对比较来评估依从性的预测因素。计算 AED 的直接成本，并以药物的年成本表示。
结果
本研究共纳入 11490 例患者，其中 51.2%为男性，48.8%为女性，平均年龄为 45.2±15.8 岁。左乙拉西坦是所有研究参与者中最常开的 AED（32.9%）。其中，49.1%的患者继续接受最初推荐的治疗。然而，31.3%的患者停止了治疗，19.6%的患者改用了其他 AED。与女性（平均年龄 44.2 岁）相比，男性（57.4%）患者对初始治疗的依从性更高。使用拉莫三嗪的患者（60.6%）表现出更高的保留初始处方药物的倾向。整个研究队列的癫痫治疗总费用为 153280.5 巴基斯坦卢比（941.9 美元）。通过应用 Cox 回归分析，可以观察到年龄增加（OR，2.04）、偏头痛（OR，2.21）、精神障碍（OR，4.28）、其他合并症（OR，1.52）和使用非前五种处方 AED 的患者（OR，2.35）更有可能停止治疗。然而，使用左乙拉西坦（OR，0.69）、丙戊酸（OR，0.52）、卡马西平（OR，0.81）、拉莫三嗪（OR，0.80）或拉考沙胺（OR，0.65）的患者更有可能继续初始治疗。
结论
与西方国家类似，大多数癫痫患者的 AED 依从性较低。本研究确定了提高依从性的各种相关因素。
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