Healthcare resource use and costs of privately insured patients who switch, discontinue, or persist on anti-muscarinic therapy for overactive bladder.
Healthcare resource use and costs of privately insured patients who switch, discontinue, or persist on anti-muscarinic therapy for overactive bladder.
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DOI：
10.3111/13696998.2014.941066
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发表时间：
2014-10-01
影响因子：
2.4
通讯作者：
Berner, Todd
中科院分区：
文献类型：
--
作者：
Ivanova, Jasmina I;Hayes-Larson, Eleanor;Berner, Todd
目的：比较膀胱过动症（OAB）患者切换和坚持使用抗毒蕈碱类药物（AMs）的医疗成本，描述停用AMs的OAB患者的资源使用和成本，并评估持续使用与切换或停用相关的因素。方法：2007年1月1日至2012年3月31日期间启动AM的OAB患者从美国私人保险受益人的索赔数据库（n1600万）中确定，并要求在AM启动前12个月内（基线期）没有AM索赔。患者被分类为持续者、转换者或停止者，并根据他们在开始治疗后6个月内的AM使用情况分配一个研究索引日期。基线特征、资源使用和成本在坚持者和其他组之间进行比较。在未调整和调整分析中，比较了研究索引日期（切换者为索引调幅切换日期；坚持者为随机指定的日期，以反映从调幅启动到切换的时间分布）前1个月和研究索引日期后6个月的资源使用和成本。对持续用药、转换或停止用药的相关因素进行了评估。结果：在控制了基线特征和成本后，坚持者与转换者在前一个月（全因1222美元vs 1759美元，oab相关142美元vs 170美元）和研究索引日期后6个月（全因7017美元vs 8806美元，oab相关642美元vs 797美元）的全因和oab相关成本均显著降低。与转换或停止治疗或持续治疗相关的因素包括指数AM、年龄较小和尿路感染史。结论：很大比例的OAB患者在开始治疗后不久就停止或切换AMs，并且切换与更高的费用相关。
OBJECTIVES: To compare the healthcare costs of patients with overactive bladder (OAB) who switch vs persist on anti-muscarinic agents (AMs), describe resource use and costs among OAB patients who discontinue AMs, and assess factors associated with persisting vs switching or discontinuing.METHODS: OAB patients initiating an AM between January 1, 2007 and March 31, 2012 were identified from a claims database of US privately insured beneficiaries (n16 million) and required to have no AM claims in the 12 months before AM initiation (baseline period). Patients were classified as persisters, switchers, or discontinuers, and assigned a study index date based on their AM use in the 6 months following initiation. Baseline characteristics, resource use, and costs were compared between persisters and the other groups. Resource use and costs in the 1 month before and 6 months after the study index date (for switchers, the date of index AM switching; for persisters, a randomly assigned date to reflect the distribution of the time from AM initiation to switching among switchers) were also compared between persisters and switchers in unadjusted and adjusted analyses. Factors associated with persisting vs switching or discontinuing were assessed.RESULTS: After controlling for baseline characteristics and costs, persisters vs switchers had significantly lower all-cause and OAB-related costs in both the month before (all-cause $1222 vs $1759, OAB-related $142 vs $170) and 6 months after the study index date (all-cause $7017 vs $8806, OAB-related $642 vs $797). Factors associated with switching or discontinuing vs persisting included index AM, younger age, and history of UTI.CONCLUSION: A large proportion of OAB patients discontinue or switch AMs shortly after initiation, and switching is associated with higher costs.