Michael Eaddy

Methods for evaluating patient adherence to antidepressant therapy: a real-world comparison of adherence and economic outcomes.

Objective:The objective of this study was to differentiate between 3 measures of antidepressant adherence with regard to the number of patients deemed adherent to therapy and the association between adherence and resource utilization. Design and Setting:The authors conducted a retrospective study of patients initiating selective serotonin reuptake inhibitor (SSRI) therapy for depression and/or anxiety between July 2001 and June 2002 in a large national managed care database. Main Outcome Measures:Rates of 6-month SSRI adherence were measured by 3 different metrics: length of therapy (LOT), medication possession ratio (MPR), and combined MPR/LOT. Differences in resource utilization for each adherence metric were measured for patients deemed as 1) adherent, 2) nonadherent, 3) therapy changers, and 4) dose titraters. Results:There were 22,947 patients meeting study criteria. Although statistically different, 6-month adherence rates were numerically similar across all methods (LOT, 44.6%; MPR, 43.3%; and MPR/LOT, 42.9%, P < 0.001); approximately 57% of patients were nonadherent to therapy. Regardless of metric, the adherent cohort incurred the lowest yearly medical costs, followed by the nonadherent, titrate, and therapy change cohorts (P < 0.001 between adherent cohort and all other cohorts). The LOT method produced the greatest difference in yearly medical costs between adherent and nonadherent patients (

Differences in Medication Adherence and Healthcare Resource Utilization Patterns : Older versus Newer Antidepressant Agents in Patients with Depression and/or Anxiety Disorders

511) followed by MPR/LOT (

Part 2: Examining pediatric vesicoureteral reflux: a real- world evaluation of treatment patterns and outcomes

432) and MPR (

Part 3: Endoscopic injection versus antibiotic prophylaxis in the reduction of urinary tract infections in patients with vesicoureteral reflux

423). When antidepressant prescription costs were added to medical costs, patients requiring a therapy change and titrating therapy incurred higher costs than adherent patients, whereas nonadherent and adherent patients incurred similar costs. Conclusion:Regardless of adherence metric, approximately 43% of patients were adherent to antidepressant therapy, and adherent patients were associated with the lowest yearly medical costs.

Impact of delaying 5-alpha reductase inhibitor therapy in men on alpha-blocker therapy to treat BPH: assessment of acute urinary retention and prostate-related surgery

AbstractBackground: Given the number of antidepressants available and their rising costs, healthcare payers have initiated restrictive reimbursement policies for newer antidepressants, without consideration for differences in their effectiveness or tolerability. Objective: The objective of this study was to comprehensively compare medication adherence rates and associated healthcare utilization costs for patients using later-generation versus earlier-generation antidepressants in a managed care setting. Antidepressants launched after 2002 were deemed third-generation antidepressants, while antidepressants available prior to 2002 were deemed first-generation (TCAs and MAOIs) and second-generation (serotonin and noradrena-line [norepinephrine]-dopamine reuptake inhibitors). Study design: Retrospective database analysis using medical and pharmacy data from over 75 managed care plans covering 55 million lives. Setting/patients: All patients receiving an antidepressant between 1 January 2002 and 30 September 2004 were identified. The index date for patients was the date of their first antidepressant prescription within this time period. Patients had to (i) have a diagnosis of depression or anxiety disorder, or depression and anxiety disorder within 6 months prior to or 30 days after their index prescription; (ii) be at least 18 years of age, without having taken antidepressant therapy for 6 months prior to their index date; and (iii) be continuously eligible for 6 months prior to their index date and during their 6-month follow-up period. Patients were excluded if they had a diagnosis of psychosis-related disease, Alzheimer’s or Parkinson’s disease, or were initiated on psychosis-related medications. Intervention/main outcome measure: Patients meeting selection criteria were followed for 6 months to assess rates of antidepressant adherence, therapy change rates and medical healthcare costs. Results:Study population: A total of 266 665 patients met the study criteria. Approximately 66% were female, with a mean age of 39 years. About 63% had a diagnosis of depression, 31% had an anxiety disorder diagnosis and 6% had diagnoses for both an anxiety disorder and depression. Therapy change: Therapy change within 6 months occurred in 18% of patients receiving third-generation agents compared with 21% and 40% for second- and first-generation agents, respectively. The odds of a therapy change were significantly lower with third-generation antidepressants compared with both older agent cohorts. Adherence: Of patients receiving third-generation antidepressants, 33.6% were adherent compared with 29.3% and 12.4% of patients receiving second- and first-generation antidepressants, respectively. Newer agents also had better adherence rates across all diagnostic cohorts. After adjusting for baseline differences, the odds of being adherent to therapy were significantly lower for those taking second- and first-generation agents versus newer antidepressants. Among the newer agents, the proportion of patients adherent to their therapy was: venlafaxine extended release 38%, paroxetine controlled release (CR) 35%, escitalopram 34%, duloxetine 32% and bupropion extended release (XL) 31%. Healthcare utilization: Of the patients taking older antidepressants, 13% (second generation) and 21% (first generation) were hospitalized at least once for any reason compared with 12% of patients taking newer agents. Overall, the odds of all-cause hospitalization within 6 months of therapy initiation were significantly higher for patients taking older antidepressants. Among the newer agents, hospitalization rates ranged from 15.9% for duloxetine to 12.5% for paroxetine CR and bupropion XL. The unadjusted 6-month total medical costs (not including pharmacy costs) per patient were

Differences in compliance patterns across the selective serotonin reuptake inhibitors (SSRIs)

US3514 for second-generation,

Real-world impact of reminder packaging on antihypertensive treatment adherence and persistence

US5744 forfirst-generation and

Economic comparison of rasburicase and allopurinol for treatment of tumor lysis syndrome in pediatric patients.

US3284 for newer antidepressants. After controlling for baseline differences, patients receiving second- and first-generation antidepressants incurred 12% and 44% higher costs, respectively. The unadjusted 6-month medical costs for the newer agents ranged from

Pediatric vesicoureteral reflux: treatment patterns and outcomes.

US2715 for paroxetine CR to SUS6042 for duloxetine. Conclusion: The results of this study provide essential information for healthcare decision makers about the potential advantages of newer generation antidepressants versus older generation antidepressants, as well as the differences between the specific newer agents, with respect to improved rates of adherence and therapy change, reduced hospitalizations and healthcare costs.

Real-world treatment patterns and associated progression-free survival in relapsed/refractory multiple myeloma among US community oncology practices

ABSTRACT Objective: Vesicoureteral reflux (VUR) occurs in 1% of infants and children. Upon diagnosis, patients are often placed on prophylactic antibiotics to prevent urinary tract infections (UTIs) and potential renal damage. The objective of this study was to assess current diagnosis and treatment patterns for patients diagnosed with VUR, focusing on compliance with antibiotic therapy and the occurrence of UTIs. Methods: This is a retrospective study of children less than 11 years of age diagnosed with VUR. Data were obtained from a national managed care database with over 45 million lives. Patients were followed for up to 6 months prior to their diagnosis and 1 year after. All were required to be eligible for medical and pharmacy services for 1 year after diagnosis. Outcome measures included the use of and compliance with prophylactic antibiotics, rates of curative treatment (surgery and endoscopic injections), and diagnoses of UTIs. Results: There were 35 450 patients meeting inclusion criteria. After being diagnosed with VUR, 76.5% of patients were placed on prophylactic antibiotics, 1.5% had open surgery, and 0.38% had an endoscopic injection with dextranomer/hyaluronic acid copolymer (Dx/HA). Only 17% of patients on prophylactic antibiotics were adherent to therapy, with mean patient compliance equaling 41.4%. Of patients on prophylactic antibiotic therapy, 58% still had a diagnosis for a UTI within 12 months of VUR diagnosis. Limitations: Adherence to VUR-related antibiotic therapy may be overestimated as the data used in the analysis represents prescriptions acquired but not necessarily consumed. This study lacked detailed clinical information, such as VUR-resolution rates and VUR grade. Conclusions: Only 17% of pediatric VUR patients on prophylactic antibiotics were compliant with therapy. Of patients on prophylactic therapy, 58% had a diagnosis of a UTI within 1 year of treatment.