Healthcare Costs and Medication Adherence Among Patients with Fibromyalgia: Combination Medication vs. Duloxetine, Milnacipran, Venlafaxine, and Pregabalin Initiators.
Healthcare Costs and Medication Adherence Among Patients with Fibromyalgia: Combination Medication vs. Duloxetine, Milnacipran, Venlafaxine, and Pregabalin Initiators.
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DOI：
10.1111/papr.12585
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发表时间：
2018-03
期刊：
影响因子：
--
通讯作者：
Short EB
中科院分区：
文献类型：
--
作者：
Marlow NM;Simpson KN;Vaughn IA;Jo A;Zoller JS;Short EB
To examine medication adherence and healthcare costs for combination prescription initiators (duloxetine/milnacipran/venlafaxine with pregabalin) versus monotherapy initiators (duloxetine, milnacipran, venlafaxine, and pregabalin) among patients with fibromyalgia syndrome (FMS). Our retrospective cohort study used claims data for the South Carolina Blue Cross Blue Shield State Health Plan (SHP). Patients with FMS aged ≥18 years, with prescription initiation from July 1, 2007 through June 30, 2010, and SHP enrollment for 12-months pre- and post-index periods were included (combination: N=100, pregabalin: N=665, duloxetine: N=713, milnacipran: N=131, venlafaxine: N=272). Medication adherence measures included high adherence (medication possession ratio ≥80%) and total supply days. Healthcare costs comprised direct medical expenditures. Propensity score methods of inverse probability of treatment weights were used to control for selection bias due to differing pre-index characteristics. Odds ratios for high adherence were significantly increased (p<0.05) among the combination cohort versus the venlafaxine (2.15), duloxetine (1.39), and pregabalin (2.20) cohorts. Rate ratios for total supply days were significantly higher (p<0.05) for combination versus venlafaxine (1.23), duloxetine (1.08), and pregabalin (1.32) cohorts. Expenditures for total healthcare were significantly higher (p<0.05) for combination versus duloxetine ($26291 versus $17190), milnacipran ($33638 versus $22886), and venlafaxine ($26586 versus $16857) cohorts. Medication adherence was considerably better for combination prescription initiators; however, expenditures for total healthcare were higher. Still, our findings suggest important clinical benefits with the use of combination prescription therapy, and prospective studies of medication adherence are warranted to examine causal relationships with outcomes not captured by healthcare claims databases.
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