Abiola O. Oladapo

ADHD medication use, adherence, persistence and cost among Texas Medicaid children

Abstract Objectives: (1) Describe ADHD medication use, adherence and persistence. (2) Determine factors (e.g., medication type, demographics, concomitant medication use) associated with ADHD medication adherence and persistence. (3) Compare ADHD medication costs. Methods: Continuously enrolled Texas Medicaid children (3–18 years) with ≥2 ADHD prescription claims (July 2002–December 2008) were included. Prescription claims were grouped by medication type (i.e., immediate-release, extended-release, prodrug, non-stimulant); medication class (i.e., stimulant, non-stimulant); and duration of action (i.e., long-acting, short-acting). Adherence, using medication possession ratio, was measured continuously and dichotomously (80% cut-off). Persistence was days of continuous therapy without a 30-day gap and medication costs were reimbursement amount paid to dispensing pharmacies. Results: The study sample (n = 62,789) was primarily 6–12 years (61.7%) and male (69.2%). The majority of the subjects were prescribed extended-release agents (70.3%), stimulant agents (86.4%), and long-acting agents (84.5%). Adherence and persistence (adherence mean ± SD; adherence dichotomous; persistence mean ± SD) varied among medication type and was highest for non-stimulants (52.5 ± 30.9; 25.8%; 153.3 ± 124.3), followed by extended-release stimulants (52.1 ± 30.2; 24.1%; 143.7 ± 120.8), prodrug stimulants (47.6 ± 30.9; 21.1%; 113.3 ± 100.5) and immediate-release stimulants (37.2 ± 27.1; 9.8%; 95.4 ± 92.6). Logistic regression showed immediate-release stimulant users were 67% less adherent than non-stimulant users (p < 0.0001) and linear regression showed immediate-release, extended-release and long-acting users (p < 0.0001) were significantly less persistent than non-stimulant users. Females, increase in total number of medications, and comorbid medications were associated with better adherence and persistence. Non-stimulant agents (

The State of Health Economic Evaluation Research in Nigeria: A Systematic Review

4.04 ± 

The state of health economic research in South Africa: a systematic review.

2.15) had the highest mean medication cost per patient per day and immediate-release stimulants had the lowest (

Review of survey articles regarding medication therapy management (MTM) services/programs in the United States.

1.24 ± 

A Retrospective Database Analysis of Neuropathic Pain and Oral Antidiabetic Medication Use and Adherence Among Texas Adults With Type 2 Diabetes Enrolled in Medicaid

0.97). Conclusions: ADHD medication adherence and persistence was suboptimal. Although there was no difference in adherence between long-acting stimulant and non-stimulant users, non-stimulant users were more persistent compared to stimulant users. This study was limited due to the use of retrospective prescription claims data, which cannot capture actual patient use patterns, ICD-9 diagnoses, family history and support, or side effect profiles. Because ADHD can be effectively treated with pharmacotherapy, providers should be proactive in identifying patients with poor adherence and intervene to address barriers to medication adherence and persistence.

Adherence to medication for attention deficit/hyperactivity disorder: does time frame matter?

This study assessed the state of health economic evaluation (including pharmacoeconomic) research in Nigeria. A literature search was conducted to identify health economic articles pertaining to Nigeria. Two reviewers independently scored each article in the final sample using a data collection form designed for the study.A total of 44 studies investigating a wide variety of diseases were included in the review. These articles were published in 34 different journals, mostly based outside of Nigeria, between 1988 and 2009. On average, each article was written by four authors. Most first authors had medical/clinical affiliations and resided in Nigeria at the time of publication of the study. Based on a 1 to 10 scale, with 10 indicating the highest quality, the mean quality score for all studies was 7.29 (SD 1.21) and 59% of the articles were of fair quality (score 5–7); 5% were of even lower quality. The quality of articles was statistically significantly (p 0.05) related to the country of residence of the primary author (non-Nigeria = higher), country of the journal (non-Nigeria = higher), primary objective of the study (economic analysis = higher) and type of economic analysis conducted (economic evaluations higher than cost studies).The conduct of health economic (including pharmacoeconomic) research in Nigeria was limited and about two-thirds of published articles were of suboptimal quality. More and better quality health economic research in Nigeria is warranted.

A Budget Impact Model of Hemophilia Bypassing Agent Prophylaxis Relative to Recombinant Factor VIIa On-Demand

BackgroundEconomic factors are a limiting factor toward the implementation of many health programmes and interventions. Economic evaluation has a great potential to contribute toward cost-effective healthcare delivery in South Africa. Little is known about the characteristics and quality of health economic (including pharmacoeconomic) research in South Africa.Objective and MethodsThis study assessed the state of health economic (including pharmacoeconomic) research in South Africa. PUBMED, MEDLINE, HealthSTAR, EconLit and PsycINFO databases were searched to identify health economic articles pertaining to South Africa published between 1 January 1977 and 30 April 2010. The searches used the following Medical Subject Headings (MeSH) terms and text words alone and in combination: ‘costs’, ‘health’ and ‘south Africa’. Our study included only original economic studies/analyses that pertained to South Africa, addressed a health-related topic, and had a statement or word in the title, abstract or keywords that indicated that an economic (including cost) analysis had been conducted. The study only included complete peer-reviewed publications (e.g. abstracts were excluded) that were reported in the English language. Two reviewers independently scored each article in the final sample using the data collection form designed for the study.ResultsIn total, 108 studies investigating a wide variety of diseases were included in the study. These articles were published in 39 different journals mostly based outside of South Africa between 1977 and 2010. On average, each article was written by three authors. Most first authors had medical/clinical training and resided in South Africa at the time of publication of their study. Based on a 1–10 scale, with 10 indicating the highest quality, the mean quality score for all studies was 7.59 (SD 1.42) and half of the articles were of good quality (score 8–10) The quality of studies was related to the country in which the journal publishing the article was based (outside South Africa = higher); current residence of the primary author (outside South Africa = higher); method of economic analysis (economic evaluations higher than cost studies); type of data used (secondary higher than primary); primary training of the first author (health economics/pharmacoeconomics = higher); type of medical function (diagnosis = higher); study perspective (societal = higher); primary health intervention (pharmaceuticals = higher); study design (modelling = higher); number of authors (more = higher); and year of publication (more recent = higher) [p≥0.05].ConclusionHalf of the articles were of poor or fair quality. Measures are needed to promote the commissioning of more and better quality health economic and pharmacoeconomic studies in South Africa.

Assessing the psychometric properties of smoking-related attitudes, self-efficacy, and intention among a diverse population of middle school students

Objective: To provide a summary of published survey articles regarding the provision of medication therapy management (MTM) services in the United States. Methods: A literature search was conducted to identify original articles on MTM-related surveys conducted in the United States, involving community and outpatient pharmacists, physicians, patients, or pharmacy students and published by the primary researchers who conducted the study. Search engines used included PubMed, Medline, and International Pharmaceutical Abstracts (IPA). If MTM was in the keyword list, mesh heading, title, or abstract, the article was reviewed. References from these articles were searched to determine whether other relevant articles were available. Results: A total of 405 articles were initially reviewed; however, only 32 articles met the study requirements. Of the 32 articles, 17 surveyed community/outpatient pharmacists, 3 surveyed pharmacy students, 4 surveyed physicians, and 8 surveyed patients. The survey periods varied across the different studies, with the earliest survey conducted in 2004 and the most recent survey conducted in 2009. The surveys were conducted via the telephone, US mail, interoffice mail, e-mails, Internet/Web sites, hand-delivered questionnaires, and focus groups. Conclusion: Despite the identified barriers to the provision of MTM services, pharmacists reportedly found it professionally rewarding to provide these services. Pharmacists claimed to have adequate clinical knowledge, experience, and access to information required to provide MTM services. Pharmacy students were of the opinion that the provision of MTM services was important to the advancement of the pharmacy profession and in providing patients with a higher level of care. Physicians supported having pharmacists adjust patients’ drug therapy and educate patients on general drug information but not in selecting patients’ drug therapy. Finally, patients suggested that alternative ways need to be explored in describing and marketing MTM services for it to be appealing to them.

Medication Effectiveness with the Use of Tumor Necrosis Factor Inhibitors Among Texas Medicaid Patients Diagnosed with Rheumatoid Arthritis

BACKGROUND Adherence to oral antidiabetic (OAD) medications is essential in achieving glycemic control and slowing the progression of diabeties-related complications such as neuropathic pain. OAD medication adherence has been suboptimal and adding neuropathic pain medications may negatively affect adherence. However, little is known about adherence to neuropathic pain medications by patients with diabetes and how this may be related to OAD medication adherence. OBJECTIVE The objectives of our study were to: (1) describe painful diabetic peripheral neuropathy (PDPN) and OAD medication use, (2) determine if PDPN medication adherence differs among individual PDPN medications (ie, tricyclic antidepressants, gabapentin, pregabalin, and duloxetine); and (3) determine if PDPN medication adherence is related to post-index OAD medication adherence while controlling for covariates. METHODS This retrospective prescription claims database study included continuously enrolled Texas Medicaid beneficiaries who were adult (aged 30-64 years) prescribed OAD (pre- and post-index) and PDPN (post-index) medications. Data were extracted from June 1, 2003 to October 31, 2009. The main study outcome was post-index OAD medication adherence. Primary independent variables included PDPN medication adherence and PDPN medication type. Demographic and medication use characteristics served as covariates. Adherence was measured both continuously and dichotomously (80% cut-off) using medication possession ratio (MPR). RESULTS The samples (n = 4277) overall mean MPR (SD) for PDPN medications was 75.4% (23.9%). Mean MPR differed significantly among individual PDPN medications (P < 0.0001) and was highest for duloxetine (85.6% [18.2%]) and lowest for pregabalin (69.4% [24.9%]). Overall mean MPR (SD) for OAD medications decreased significantly (P < 0.0001) from 73.0% (24.3%) in the pre-index period to 64.5% (25.6%) in the post-index period. After controlling for covariates, nonadherers (ie, MPR <80%) to PDPN medications, compared with adherers (ie, MPR ≥80%), were significantly less likely to be adherent to OAD medications in the post-index period (odds ratio = 0.626; 95% CI, 0.545-0.719). CONCLUSIONS Overall, these data suggest that mean adherence to both PDPN and OAD medications was suboptimal (MPR <80%). Patients who were adherent to PDPN medications were more adherent to OAD medications in the post-index period, but OAD medication adherence was independent of the type of PDPN medication used. OAD adherence decreased from pre- to post-index (ie, when patients were prescribed PDPN medications), which may indicate an opportunity for practitioners to emphasize the importance of OAD adherence in reducing the progression to neuropathy.

The need for more evidence-based studies to justify the economic value for the provision of medication therapy management and other clinical pharmacy services.

Objectives  Attention deficit/hyperactivity disorder (ADHD) medication users frequently take ‘drug holidays’ during the summer months. The study objective was to compare ADHD medication adherence for the school year (SY, 270 days) and for the entire year (EY, 365 days) by medication type, medication class and duration of action.