Johnsrud Michael, Richards Kristin, Arcona Steve, Sasané Rahul, Leoni Matthew
TxCORE (Texas Center for Health Outcomes Research and Education), The University of Texas at Austin, 2409 University Avenue, Austin, TX 78712, USA.
Cerevel Therapeutics, 222 Jacobs Street, Suite 200, Cambridge, MA 02141, USA.
Clin Park Relat Disord. 2021 Sep 27;5:100109. doi: 10.1016/j.prdoa.2021.100109. eCollection 2021.
Most Parkinson's disease (PD) medication adherence studies have focused on patients with commercial or Medicare health insurance coverage. However, less is known regarding medication treatment patterns within the Medicaid population.
This retrospective cohort study utilized 2011-2019 administrative healthcare claims from 7 state Medicaid programs. We compared newly diagnosed patients with PD started on either levodopa or a dopamine agonist (DA). Baseline comorbidities were compared. Outcomes were assessed during a 12-month post-index observation period, and included total medication days, proportion of days covered (PDC), adherence status, persistence to initiating PD medication, and time to non-persistence of initiating PD medication.
Our study sample of 805 Medicaid patients had an average age of 54.1 years, with 52.0% being female. Levodopa was the predominant PD medication at initiation (75.4%). Roughly half of patients had a baseline depressive disorder and nearly 40% had an anxiety disorder. Levodopa patients had a significantly higher PDC compared to DA patients (0.621 vs. 0.546, p = 0.007). An adjusted logistic regression model showed no significant difference in the number of adherent patients between the two groups (p = 0.058). An adjusted Cox proportional hazards model controlling for demographic and baseline variables showed a 26% lower risk of non-persistence for levodopa patients versus DA patients (HR 0.740, CI 0.597-0.917, p = 0.006).
Adherence and persistence rates were suboptimal following initiation of either levodopa or DA medication for patients with PD in Medicaid programs, though rates were better for those initiated on levodopa.
大多数帕金森病（PD）药物依从性研究都集中在拥有商业保险或医疗保险覆盖的患者身上。然而，关于医疗补助人群的药物治疗模式，我们了解得较少。
这项回顾性队列研究利用了7个州医疗补助项目2011 - 2019年的行政医疗保健索赔数据。我们比较了新诊断为帕金森病且开始使用左旋多巴或多巴胺激动剂（DA）的患者。比较了基线合并症情况。在索引后12个月的观察期内评估结果，包括总用药天数、覆盖天数比例（PDC）、依从状态、开始使用帕金森病药物后的持续用药情况以及开始使用帕金森病药物后不再持续用药的时间。
我们研究中的805名医疗补助患者样本平均年龄为54.1岁，其中52.0%为女性。左旋多巴是起始时主要的帕金森病药物（75.4%）。大约一半的患者有基线抑郁症，近40%有焦虑症。左旋多巴患者的PDC显著高于DA患者（0.621对0.546，p = 0.007）。调整后的逻辑回归模型显示两组间依从患者数量无显著差异（p = 0.058）。控制人口统计学和基线变量的调整后Cox比例风险模型显示，左旋多巴患者不再持续用药的风险比DA患者低26%（风险比0.740，置信区间0.597 - 0.917，p = 0.006）。
在医疗补助项目中，帕金森病患者开始使用左旋多巴或DA药物后的依从性和持续用药率不理想，不过开始使用左旋多巴的患者情况较好。
