Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK; Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
J Cyst Fibros. 2022 Mar;21(2):323-331. doi: 10.1016/j.jcf.2021.09.007. Epub 2021 Sep 23.
Studies in separate cohorts suggest possible discrepancies between inhaled medicines supplied (median 50-60%) and medicines used (median 30-40%). We performed the first study that directly compares CF medicine supply against use to identify the cost of excess medicines supply.
This cross-sectional study included participants from 12 UK adult centres with ≥1 year of continuous adherence data from data-logging nebulisers. Medicine supply was measured as medication possession ratio (MPR) for a 1-year period from the first suitable supply date. Medicine use was measured as electronic data capture (EDC) adherence over the same period. The cost of excess medicines was calculated as whole excess box(es) supplied after accounting for the discrepancy between EDC adherence and MPR with 20% contingency.
Among 275 participants, 133 (48.4%) were females and mean age was 30 years (95% CI 29-31 years). Median EDC adherence was 57% (IQR 23-86%), median MPR was 74% (IQR 46-96%) and the discrepancy between measures was median 14% (IQR 2-29%). Even with 20% contingency, mean potential cost of excess medicines was £1,124 (95% CI £855-1,394), ranging from £183 (95% CI £29-338) for EDC adherence ≥80% to £2,017 (95% CI £1,507-2,526) for EDC adherence <50%.
This study provides a conservative estimate of excess inhaled medicines supply cost among adults with CF in the UK. The excess supply cost was highest among those with lowest EDC adherence, highlighting the importance of adherence support and supplying medicine according to actual use. MPR provides information about medicine supply but over-estimates actual medicine use.
多项独立队列研究表明，吸入药物的供应（中位数为 50-60%）与实际使用（中位数为 30-40%）之间可能存在差异。我们进行了第一项直接比较 CF 药物供应与使用情况的研究，以确定过度供应药物的成本。
这项横断面研究纳入了来自英国 12 个成人中心的参与者，这些参与者在使用数据记录雾化器时具有至少 1 年的连续依从性数据。药物供应通过药物持有率（MPR）来衡量，为期 1 年，从首次合适的供应日期开始计算。药物使用通过同期的电子数据捕获（EDC）依从性来衡量。通过考虑 EDC 依从性与 MPR 之间的差异以及 20%的意外情况，计算出过度供应药物的总成本，具体为超出 EDC 依从性与 MPR 之间差异的整盒（数）药物。
在 275 名参与者中，有 133 名（48.4%）为女性，平均年龄为 30 岁（95%CI 29-31 岁）。EDC 依从性中位数为 57%（IQR 23-86%），MPR 中位数为 74%（IQR 46-96%），两者之间的差异中位数为 14%（IQR 2-29%）。即使考虑到 20%的意外情况，平均潜在过度药物供应成本为 1124 英镑（95%CI 855-1394 英镑），范围从 EDC 依从性≥80%的 183 英镑（95%CI 29-338 英镑）到 EDC 依从性<50%的 2017 英镑（95%CI 1507-2526 英镑）。
本研究提供了英国 CF 成年患者吸入性药物过度供应成本的保守估计。EDC 依从性最低的患者过度供应成本最高，这突显了提供药物时需要关注依从性支持以及根据实际使用情况供应药物的重要性。MPR 提供了药物供应的信息，但高估了实际药物使用情况。
