Treatment interruptions and non-adherence with imatinib and associated healthcare costs - A retrospective analysis among managed care patients with chronic myelogenous leukaemia
Treatment interruptions and non-adherence with imatinib and associated healthcare costs - A retrospective analysis among managed care patients with chronic myelogenous leukaemia
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DOI：
10.2165/00019053-200725060-00004
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发表时间：
2007-01-01
影响因子：
4.4
通讯作者：
Cortes, Jorge
中科院分区：
文献类型：
--
作者：
Darkow, Theodore;Henk, Henry J.;Cortes, Jorge
目的：识别治疗中断和不遵守伊马替布；检查与治疗中断和不遵守治疗相关的临床和患者特征；评估治疗中断与不坚持使用伊马替布和美国管理下的慢性髓系白血病(CML)患者的医疗费用之间的关系。方法：这项回顾分析利用了来自美国管理下的医疗提供者的电子医疗索赔数据。2001年6月1日至2004年3月31日期间开始使用伊马替尼治疗的成年慢性粒细胞白血病患者(由国际疾病分类第九次修订，临床修改[ICD-9-CM]诊断代码确定)。在12个月的随访期内发现了治疗中断(即自先前处方用完之日起30天内未补充伊马替尼)。药物持有率(MPR)，计算为伊马替尼总天数除以365，也进行了检查。医疗成本(即所有处方药和医疗服务的支付金额，包括健康计划和患者责任)通过三种方式进行审查：(I)医疗总成本；(Ii)不包括伊马替布成本的医疗总成本；以及(Iii)医疗总成本。使用消费者物价指数的医疗部分将所有费用转换为美元(2004年价值)。MPR使用普通最小二乘回归建模。使用Logistic回归对治疗中断的存在进行建模。使用由伽马误差分布和对数链接指定的广义线性模型来估计MPR和医疗费用之间的关联。所有模型都包括对年龄、性别、联合用药数量、伊马替尼起始量和癌症复杂性的调整。结果：总共确定了267名患者。平均年龄约为50岁，其中43%是女性。平均MPR为77.7%，31%的患者治疗中断。然而，所有这些患者在研究期间都恢复了伊马替尼。在这一人群中，mpr随着伴随药物数量的增加而降低(p=0.002)，在女性(p=0.003)、癌症复杂性高的患者(p=0.003)和伊马替尼起始剂量较高的患者(p=0.04)中更低。女性中断治疗的可能性大约是男性的两倍(p=0.009)，癌症复杂性较高的患者(p=0.03)。在调整了前述协变量后，研究发现，除伊马替尼(p<；0.001)和医疗费用(p<；0.001)外，mpr与医疗费用呈负相关。MPR的10%的差异与不包括伊马替布的医疗成本的14%的差异和医疗成本的15%的差异相关。例如，与MPR为85%的患者相比，MPR为75%的患者每年多花费4072美元的医疗费用。结论：治疗中断和不坚持使用伊马替布似乎很普遍，这两种情况都可能导致不希望看到的临床和经济结果。医生和药剂师应该教育患者并密切监测治疗的依从性，因为提高依从性和限制治疗中断不仅可以优化临床结果，还可以减轻慢性粒细胞白血病的经济负担。
Objectives: Identify treatment interruptions and non-adherence with imatimb; examine the clinical and patient characteristics related to treatment interruptions and non-adherence; and estimate the association between treatment interruptions and non-adherence with imatimb and healthcare costs for US managed care patients with chronic myeloid leukaemia (CML).Methods: This retrospective analysis utilised electronic healthcare claims data from a US managed care provider. Adult patients with CML (as determined by International Classification of Diseases, ninth revision, Clinical Modification [ICD-9-CM] diagnosis code) were identified who began treatment with imatinib from I June 2001 through 31 March 2004. Treatment interruptions (i.e. failure to refill imatinib within 30 days from the run-out date of the prior prescription) were identified during the 12-month follow-up period. Medication possession ratio (MPR), calculated as total days' supply of imatinib divided by 365, was also examined. Healthcare costs (i.e. paid amounts for all prescription medications and medical services received, including health plan and patient liability) were examined in three ways: (i) total healthcare costs; (ii) total healthcare costs exclusive of imatimb costs; and (iii) total medical costs. All costs were converted to $US (2004 values) using the medical component of the Consumer Price Index.MPR was modelled using ordinary least squares regression. Presence of treatment interruptions was modelled using logistic regression. The association between MPR and healthcare costs was estimated using a generalised linear model specified with a gamma error distribution and a log link. All models included adjustment for age, gender, number of concomitant medications, starting dose of imatinib and cancer complexity.Results: A total of 267 patients were identified. Average age was approximately 50 years, and 43% were women. Mean MPR was 77.7%, with 31% of patients having a treatment interruption. However, all of these patients resumed imatinib within the study period. In this population, MPR decreased as the number of concomitant medications increased (p = 0.002), and was lower among women (p = 0.003), patients with high cancer complexity (p = 0.003) and patients with a higher starting dose of imatinib (p = 0.04). Women were approximately twice as likely as men to have a treatment interruption (p = 0.009), as were patients with a high cancer complexity (p = 0.03). After adjusting for the aforementioned covariates, MPR was found to be inversely associated with healthcare costs excluding imatinib (p < 0.001) and medical costs (p < 0.001). A 10% point difference in MPR was associated with a 14% difference in healthcare costs excluding imatimb and a 15% difference in medical costs. For example, patients with an MPR of 75% incur an additional $US4072 in medical costs annually compared with patients with an MPR of 85%.Conclusions: Treatment interruptions and non-adherence with imatimb, both of which could lead to undesired clinical and economic outcomes, appear to be prevalent. Physicians and pharmacists should educate patients and closely monitor adherence to therapy, as improving adherence and limiting treatment interruptions may not only optimise clinical outcomes but also reduce the economic burden of CML.