Trends in RA patients' adherence to subcutaneous anti-TNF therapies and costs
Trends in RA patients' adherence to subcutaneous anti-TNF therapies and costs
复制标题
DOI：
10.1185/03007990902896386
复制
发表时间：
2009-06-01
影响因子：
2.3
通讯作者：
Globe, Denise
中科院分区：
文献类型：
--
作者：
Borah, Bijan J.;Huang, Xingyue;Globe, Denise
目的：研究类风湿性关节炎（RA）患者阿达木单抗（ADA）和依那西普（ETA）的依从性和医疗费用，并探讨依从性、利用率和费用之间的关系。研究设计和方法：使用来自大型管理医疗保健计划的行政索赔数据，确定了2005年1月1日至2005年12月31日期间接受依那西普或阿达木单抗治疗的RA患者。首次分发日期定义为索引日期。患者的依从性和成本在1年后的索引periods.Main结局措施进行了评估：非依从性（药物拥有率580%）采用logistic回归建模。使用考克斯比例风险（PH）模型估计比较至停药时间的风险比（HR）。结果：3829例RA患者中，ADA和ETA分别为1292例（765例现有，527例初治）和2537例（1834例现有，703例初治）。与ADA使用者相比，ETA使用者的平均治疗持续时间更长（316 vs. 291天; p < 0.0001）。初治和现有使用者的未调整依从率分别为63%和70%（ADA），65%和73%（ETA）。Logistic回归分析表明，与ETA使用者相比，ADA使用者更可能不依从（OR，初治1.24;现有; 1.25）。考克斯PH模型表明，现有ADA使用者比现有ETA使用者更有可能停用药物（HR=1.11; p=0.06）。与ADA使用者相比，ETA使用者的RA相关药房费用显著降低（初治：10，892美元对比12，534美元，p < 0.01;现有：12，192美元对比13，752美元，p < 0.01）和RA相关总成本结论：与ADA使用者相比，ETA使用者的治疗持续时间更长，更可能坚持他们的药物治疗方案，RA相关的药房和RA相关的总费用更低。必须在本数据库分析的限制范围内考虑这些结果。
Objective: To examine adherence to adalimumab (ADA) and etanercept (ETA) and health care costs in rheumatoid arthritis (RA) patients, and to explore the association between adherence, utilization and costs.Research design and methods: Using administrative claims data from a large managed health care plan, RA patients treated with etanercept or adalimumab during the period from 01/01/2005 through 12/31/2005 were identified. The first dispensing date was defined as the index date. Patient adherence and costs were assessed during the 1 year post-index period.Main outcome measures: Nonadherence (medication possession ratio 580%)was modeled using logistic regression. Hazard ratios (HR) comparing time to discontinuation were estimated using Cox proportional hazard (PH) models. Propensity score matching with multivariate generalized linear modeling adjustment was done to assess cost difference between ADA and ETA.Results: Of 3829 eligible RA patients, 1292 (765 existing, 527 naive) and 2537 (1834 existing, 703 naive) patients used ADA and ETA, respectively. Compared with ADA users, ETA users had longer average treatment duration (316 vs. 291 days; p < 0.0001). Unadjusted adherence rates for naive and existing users were 63% and 70% (ADA), and 65% and 73% (ETA). Logistic regression analysis indicated that compared with ETA users, ADA users were more likely to be nonadherent (OR, naive 1.24; existing; 1.25). Cox PH models indicated that existing ADA users were more likely to discontinue (HR=1.11; p=0.06) their medication than existing ETA users. Compared with ADA users, ETA users had significantly lower RA-related pharmacy costs (naive: $10,892 vs. $12,534, p < 0.01;existing: $12,192 vs. $13,752, p < 0.01) and RA-related total costs (naive: $11,976.42 vs. $13,511.99, p < 0.05; existing: $14,031 vs. $15,454, p < 0.05).Conclusions: ETA users had longer treatment duration, were more likely to adhere to their medication regimen and had lower RA-related pharmacy and RA-related total costs compared with ADA users. These findings must be considered within the limitations of this database analysis.