Adherence and persistence to urate-lowering therapies in the Irish setting

Hdl Handle:
http://hdl.handle.net/10147/336270
Title:
Adherence and persistence to urate-lowering therapies in the Irish setting
Authors:
McGowan, Bernie; Bennett, Kath; Silke, Carmel; Whelan, Bryan
Citation:
Adherence and persistence to urate-lowering therapies in the Irish setting 2014 Clinical Rheumatology
Journal:
Clinical Rheumatology
Issue Date:
Nov-2014
URI:
http://hdl.handle.net/10147/336270
DOI:
10.1007/s10067-014-2823-8
Additional Links:
http://link.springer.com/10.1007/s10067-014-2823-8
Abstract:
To identify adherence and persistence levels with urate-lowering therapies using the national administrative pharmacy claim database. This was a retrospective, pharmacy claims-based analysis of dispensed anti-gout medications on the Irish national HSE-PCRS scheme database between January 2008 and December 2012. Adherence is defined by the medication possession ratio (MPR), and patients were considered to be adherent if the MPR ≥80 % (good adherers) in any given time period. Persistence was defined as continued use of therapy with no periods exceeding a refill gap of >63 days (9 weeks). Logistic regression analysis was used to predict odd ratios (OR) and 95 % confidence interval (CI) for persistence and adherence in relation to age, gender and level of comorbidity. There was a 53 % increase in the number of patients prescribed anti-gout medications between 2008 and 2012 with an increase of 27 % in the associated ingredient cost of these medications. Allopurinol accounted for 87 % of the prescribing and febuxostat accounted for a further 9 %. In patients who started on 100 mg allopurinol, only 14.6 % were titrated to the 300 mg dose. For all those initiating urate-lowering therapies, 45.8 % of patients were persistent with treatment at 6 months decreasing to 22.6 % at 12 months. In multivariate analysis, females had poorer adherence (OR = 0.83 (0.77-0.90)), and increasing age was associated with increased adherence (OR = 4.19 (2.53-6.15)) Increasing comorbidity score was associated with increased adherence and persistence at 6 months (OR = 0.68 (0.59-0.79)). Adherence with anti-gout medications in this study cohort was relatively low. Sustained treatment for gouty arthritis is essential in the prevention of serious adverse outcomes.Significance and Innovations-Poor adherence to medications prescribed to patients for the management of chronic diseases such as gout is an ongoing problem which urgently needs to be addressed.-Some of the reasons identified for poor adherence to anti-gout medications include the risk of flare of acute gout with the initiation of urate-lowering therapy (ULT), poor response to ULT and persistence of attacks of acute gout, suboptimal dosing of allopurinol therapy and intolerance of allopurinol.-The results of this study identified adherence and persistence rates of approximately 50 % at 6 months which is in line if not lower than many of the other published studies to date which have measured adherence and persistence using pharmacy claims databases.-The results of poor adherence and persistence affect both the health of the patients with financial implications for the healthcare service.
Item Type:
Article
Language:
en
Keywords:
MEDICATION MANAGEMENT; HEALTH POLICY; FINANCE
ISSN:
0770-3198; 1434-9949

Full metadata record

DC FieldValue Language
dc.contributor.authorMcGowan, Bernieen_GB
dc.contributor.authorBennett, Kathen_GB
dc.contributor.authorSilke, Carmelen_GB
dc.contributor.authorWhelan, Bryanen_GB
dc.date.accessioned2014-11-27T14:31:19Z-
dc.date.available2014-11-27T14:31:19Z-
dc.date.issued2014-11-
dc.identifier.citationAdherence and persistence to urate-lowering therapies in the Irish setting 2014 Clinical Rheumatologyen_GB
dc.identifier.issn0770-3198-
dc.identifier.issn1434-9949-
dc.identifier.doi10.1007/s10067-014-2823-8-
dc.identifier.urihttp://hdl.handle.net/10147/336270-
dc.description.abstractTo identify adherence and persistence levels with urate-lowering therapies using the national administrative pharmacy claim database. This was a retrospective, pharmacy claims-based analysis of dispensed anti-gout medications on the Irish national HSE-PCRS scheme database between January 2008 and December 2012. Adherence is defined by the medication possession ratio (MPR), and patients were considered to be adherent if the MPR ≥80 % (good adherers) in any given time period. Persistence was defined as continued use of therapy with no periods exceeding a refill gap of >63 days (9 weeks). Logistic regression analysis was used to predict odd ratios (OR) and 95 % confidence interval (CI) for persistence and adherence in relation to age, gender and level of comorbidity. There was a 53 % increase in the number of patients prescribed anti-gout medications between 2008 and 2012 with an increase of 27 % in the associated ingredient cost of these medications. Allopurinol accounted for 87 % of the prescribing and febuxostat accounted for a further 9 %. In patients who started on 100 mg allopurinol, only 14.6 % were titrated to the 300 mg dose. For all those initiating urate-lowering therapies, 45.8 % of patients were persistent with treatment at 6 months decreasing to 22.6 % at 12 months. In multivariate analysis, females had poorer adherence (OR = 0.83 (0.77-0.90)), and increasing age was associated with increased adherence (OR = 4.19 (2.53-6.15)) Increasing comorbidity score was associated with increased adherence and persistence at 6 months (OR = 0.68 (0.59-0.79)). Adherence with anti-gout medications in this study cohort was relatively low. Sustained treatment for gouty arthritis is essential in the prevention of serious adverse outcomes.Significance and Innovations-Poor adherence to medications prescribed to patients for the management of chronic diseases such as gout is an ongoing problem which urgently needs to be addressed.-Some of the reasons identified for poor adherence to anti-gout medications include the risk of flare of acute gout with the initiation of urate-lowering therapy (ULT), poor response to ULT and persistence of attacks of acute gout, suboptimal dosing of allopurinol therapy and intolerance of allopurinol.-The results of this study identified adherence and persistence rates of approximately 50 % at 6 months which is in line if not lower than many of the other published studies to date which have measured adherence and persistence using pharmacy claims databases.-The results of poor adherence and persistence affect both the health of the patients with financial implications for the healthcare service.en_GB
dc.language.isoenen
dc.relation.urlhttp://link.springer.com/10.1007/s10067-014-2823-8en_GB
dc.rightsArchived with thanks to Clinical Rheumatologyen_GB
dc.subjectMEDICATION MANAGEMENTen_GB
dc.subjectHEALTH POLICYen_GB
dc.subjectFINANCEen_GB
dc.titleAdherence and persistence to urate-lowering therapies in the Irish settingen_GB
dc.typeArticleen
dc.identifier.journalClinical Rheumatologyen_GB
dc.description.fundingNo fundingen
dc.description.provinceConnachten
dc.description.peer-reviewpeer-reviewen
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