Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
JAMA Netw Open. 2023 Oct 2;6(10):e2337971. doi: 10.1001/jamanetworkopen.2023.37971.
The adverse effects of prescription drug costs on medication adherence and health have been well described for individuals. Because many families share financial resources, high medication costs for one could lead to cost-related nonadherence in another; however, these family-level spillover effects have not been explored.
To evaluate whether the cost of a child's newly initiated medication was associated with changes in their parent's adherence to their own medications and whether that differed by likely duration of treatment.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used interrupted time-series analysis with a propensity score-matched control group from a large national US health insurer database (2010-2020) and included children initiating medication and their linked presumed parents using long-term medications.
The cost of the child's initiated medication. Child medication cost was classified based on highest (≥90th) or lowest (<10th) decile from out-of-pocket medication spending, stratified by whether the medication was intended for short- or long-term use. Children initiating high-cost medications (based on the highest decile) were propensity-score matched with children initiating low-cost medications.
The child's parent's adherence to long-term medication assessed by the widely used proportion of days covered metric in 30-day increments before and after the child's first fill date. Parent demographic characteristics, baseline adherence, and length of treatment, and family unit size and out-of-pocket medication spending were key subgroups.
Across 47 154 included pairs, the parents' mean (SD) age was 42.8 (7.7) years. Compared with a low-cost medication, initiating a high-cost, long-term medication was associated with an immediate 1.9% (95% CI, -3.8% to -0.9%) reduction in parental adherence sustained over time (0.2%; 95% CI, -0.1% to 0.4%). Similar results were observed for short-term medications (0.6% immediate change; 95% CI, -1.3% to -0.01%). Previously adherent parents, parents using treatment for longer periods, and families who spent more out-of-pocket on medications were more sensitive to high costs, with immediate adherence reductions of 2.8% (95% CI, -4.9% to -0.6%), 2.7% (95% CI, -4.7% to -0.7%), and -3.8% (95% CI, -7.2% to -0.5%), respectively, after long-term medication initiation.
In this cohort study small reductions in adherence across parents with higher child drug costs were observed. Health care systems should consider child-level or even household-level spending in adherence interventions or prescription policy design.
药物成本对个人用药依从性和健康的不良影响已经得到了充分的描述。由于许多家庭共享经济资源，一个人的高药物费用可能导致另一个人的药物费用相关不依从；然而，这些家庭层面的溢出效应尚未得到探讨。
评估儿童新处方药物的费用是否与父母自身药物治疗的依从性变化相关，以及这种变化是否因可能的治疗持续时间而异。
设计、地点和参与者：这项基于倾向评分匹配对照组的大型美国全国健康保险公司数据库的队列研究（2010-2020 年），包括开始服用药物的儿童及其使用长期药物的关联假定父母。
儿童新处方药物的费用。根据自付药物支出的最高（≥第 90 百分位）或最低（<第 10 百分位）十分位数，对儿童药物费用进行分类，按药物短期或长期使用分层。根据最高十分位数，将高成本药物（高成本药物）的儿童与低成本药物（低剂量药物）的儿童进行倾向评分匹配。
儿童家长对长期药物的依从性，通过广泛使用的覆盖天数比例在儿童首次配药日期前后 30 天的增量进行评估。家长的人口统计学特征、基线依从性、治疗持续时间以及家庭单位规模和自付药物支出是关键亚组。
在 47154 对纳入的儿童中，父母的平均（SD）年龄为 42.8（7.7）岁。与低费用药物相比，高费用、长期药物的初始治疗与父母的依从性立即降低 1.9%（95%CI，-3.8%至-0.9%），并且这种降低可持续一段时间（0.2%；95%CI，-0.1%至 0.4%）。短期药物也观察到类似的结果（即时变化 0.6%；95%CI，-1.3%至-0.01%）。以前依从的父母、使用治疗时间较长的父母和自付药物支出较高的家庭对高费用更为敏感，长期药物治疗开始后，其依从性立即降低 2.8%（95%CI，-4.9%至-0.6%）、2.7%（95%CI，-4.7%至-0.7%）和-3.8%（95%CI，-7.2%至-0.5%）。
在这项队列研究中，观察到父母的药物费用较高时，其药物依从性会略有降低。医疗保健系统在进行药物依从性干预或处方政策设计时，应考虑儿童层面甚至家庭层面的支出。
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