Paola Sorice

Patient Adherence and Persistence with Imatinib, Nilotinib, Dasatinib in Clinical Practice

Introduction The aim of this study is to evaluate adherence and persistence of patients treated with Imatinib, Nilotinib or Dasatinib, also giving economic evaluations on therapy costs for Received Daily Dose (RDD). Materials and Methods In this retrospective study, we took into account 3 years from 1st Jan. 2009 to 31st March.2012. Treatment adherence was quantified utilizing ratio between RDD and PDD (Prescribed Daily Dose). Persistence is reckoned taking into account the actual therapy days, comparing posology with supplied dose, drawing the graph using Kaplan-Meir method. Results Adherence results in values between 0.8 and 1.0 for Nilotinib (Adh  = 0.93), Imatinib (Adh  = 0.83) and Dasatinib (0.85). Imatinib has better persistence, 90% of patients in treatment exceed one year of treatment versus 83.3% for Nilotinib and 80% for Dasatinib. The cost per single day of treatment (cost per RDD) was € 39.41 for Imatinib, € 113.60 for Nilotinib and € 94.84 for Dasatinib. Conclusion Patients with CML have a loose of adherence both in first line with Imatinib and in second line of therapy with Dasatinib and Nilotinib. Loss of adherence remains a big problem and could be minimized by a patient-oriented project invlolving physicians, nurses, pharmacists and caregiver.

Medication adherence and persistence in the treatment of rheumatoid arthritis with adalimumab and etanercept. Six years of analysis.

Abstract Objective: The aim of this study was to evaluate medication adherence and persistence of patients treated with Etanercept and Adalimumab for Rheumatoid Arthritis, also giving economic evaluations on therapy costs for Received Daily Dose (RDD). Materials and methods: This retrospective study took into account 6 years from January 1, 2007 to December 31, 2012. Medication adherence was quantified utilizing the ratio between RDD and Prescribed Daily Dose (PDD). Persistence has been reckoned taking into account the actual days of therapy comparing posology with supplied dose. The persistence has been graphed according to Kaplan-Meier method. The cost per RDD was reckoned starting from the expense incurred by Pescara General Hospital. Results: Medication adherence gave results in values between 0.88–0.97 for Etanercept and 0.83–0.90 for Adalimumab. The value of persistence was 100% for Etanercept and 90% for Adalimumab for the first year, and 70% for Etanercept and 80% for Adalimumab for the second year. In the 3rd year the persistence for Etanercept was 50% while for Adalimumab it was 60%. In the fourth year the persistence for Etanercept was 21% while for Adalimumab it was 27%. The statistical analysis was conducted using the Log rank test. The average cost per RDD was €32.97 for Etanercept and for Adalimumab it was €32.00 as an average of 6 years. Conclusion: The medication adherence was good for both Etanercept and Adalimumab. The rate of persistence decreased strictly in the fourth year of treatment. This data suggests the need for continuous monitoring of patients in treatment with TNF blockers.

Leuprorelin and Triptorelin in the treatment of Prostate Cancer: Medication adherence, Persistence and Economic Evaluation in Five Years of Analysis

Background: A successful of home treatment is strongly influenced by patient adherence to treatment. Non-adherence represents not only an important issue for the patient, affecting both the clinical efficacy and safety of the medication regimen, but also has economical and social implication for the community. Objective: The aim of this study is to evaluate medication adherence, persistence to treatment and daily cost of therapy in patients with prostate cancer treated with gonadotropin-releasing hormone agonists, comparing Leuprorelin 3.75mg-11.25mg and Triptorelin 3.75mg-11.25mg. Materials and Methods: The study was carried out from 2007 to 2012 in an Italian Hospital in Pescara. This is a General Hospital with 800 beds. Medication adherence was measured as the ratio between the Received Daily Dose (RDD) and the Prescribed Daily Dose (PDD), using software developed ad hoc by the hospital pharmacists. The RDD was calculated dividing the dose of drug dispensed in a pharmacy refill by the sum of days between two consecutive drug refills. PDD was determined in basis of the treatment regimen as prescribed by physician. The non-persistence was calculated like the effective days of treatment, that is the sum of days elapsing between the first and the last pharmacy refill, plus the days of treatment supplied with the last refill, minus the days of non-persistence, and it was graphically represented by the Kaplan Meier curves. The daily cost of treatment was calculated on the basis of the RDD. Results: The patients included in this study were 239 for Leuprorelin and 199 for Triptorelin. The adherence values for all drugs ranged between from 0.92 to 1.00, showing good quality management of treatment at home. The analysis of non-persistence conducted in four years (with patients included until 31 December 2007) showed a decrease by a 21% for Leuprorelin and 38% for Triptorelin, using the Log Rank Test the persistence for two drugs are not significantly different. The cost per RDD was of € 2.24 for Leuprorelin and € 2.84 for Triptorelin. Conclusion: Often health personnel have not a precise idea on behavior of patient in home therapy for chronic disease; calculation of adherence is very important to know what the real pharmacoutilization of drugs is, and our results showed a good profile of medication adherence for both drugs studied. Economic results give a difference of 60 cent per day, one year of therapy with Triptorelin is approximately € 219 more expensive than Leuprorelin per patient; we think that this kind of comparisons would be encouraged, that could be really useful for decisors of National Regulatory Agencies to negotiate the pricing of drugs on the basis of the real utilization in clinical practice, and for clinicians to make a good cost-effectiveness choice.

GRP-012 Adherence, Persistence and Financial Evaluation in the Treatment of Prostate Cancer

Background The success of home treatment is strongly influenced by patient adherence to treatment. Non-adherence to treatment represents not only an important issue for the patient, affecting both the clinical efficacy and safety of the drug treatment, but also has financial and social implications for the community. Purpose This study evaluated the adherence to treatment, persistence, and the daily cost of treatment in patients with prostate cancer treated with gonadotropin-releasing hormone agonists, comparing leuprorelin 3.75–11.25, leuprorelin 7.5–22.5 and triptorelin. Materials and Methods Adherence to treatment was measured as the ratio between the Received Daily Dose (RDD) and the Prescribed Daily Dose (PDD), using software developed for this purpose by hospital pharmacists. The RDD was calculated as the sum of the number of days between two consecutive drug refills, whilst the PDD was determined based on the treatment regimen as prescribed by the physician. The persistence was calculated as the sum of the number of days the patient had stayed on treatment. The cost of daily treatment was calculated on the basis of the RDD. Results 126 patients were enrolled in this study for triptorelin, 143 for leuprorelin 3.75–11.25 and 31 for leuprorelin 7.5–22.5. The adherence values for all drugs ranged between 0.95 and 1.10, showing good quality management of domiciled treatment. The analysis of persistence conducted over three years showed a decrease by 20% for leuprorelin 3.75–11.25, 25% for triptorelin and 50% for leuprorelin 7.5–22.5. The cost per RDD was €.2.15, €.2.24 and €.2.84 for leuprorelin 7.5–22.5, leuprorelin 3.75–11.25 and triptorelin respectively. Conclusions The excellent adherence values showed that all the drugs studied have a good safety profile and easy administration. In fact, patients complied with the dosage and medication regimens as recommended by prescribers. The persistence values were overlapping. The cost per RDD for triptorelin was 23% higher than leuprorelin. No conflict of interest.

GRP-010 Adherence to Oral Cancer Treatment: The Role of the Hospital Pharmacist in Therapeutic Success

Background The management of cancer treatment has changed considerably in recent years with the entry into the market of novel oral cancer agents. Although treatment at home improves patient compliance, in practise it’s difficult to assess the quality of treatment without the supervision of healthcare professionals. Purpose To monitor patients at home and to assess the variables influencing adherence to treatment. We sought to educate, discuss and establish effective communication with patients in order to minimise the barriers between patients and physicians. Materials and Methods From July 2012, hospital pharmacists have provided their haematology-oncology patients with a self-report medicines diary. Patients were asked to write the date, time, treatment dosage and concomitant treatments, as well as to describe their health status and report any side effects. Data were saved in a database created for the purpose. Treatment adherence was calculated as Medicines Possession Ratio according to the treatment indications in the patient diary. Results From July 2012 to October 2012, a total of 261 patients were asked to participate in the study and to fill out a self-reported diary. 243 patients agreed to participate in the study, of these 86 completed and returned the self-report diaries (41%) to the hospital pharmacy. The percentage of adherence to treatment was significantly higher in those patients who completed the medicines diaries compared to those who did not use the medicines diary (0.99 vs. 0.88). The reported side effects indicated that medicines were well tolerated and did not cause discontinuation of treatment. Conclusions The preliminary data of this patient-oriented research emphasises the importance of promoting dialogue in order to optimise home treatment. The hospital pharmacist plays a key role in promoting and improving adherence to treatment by analysing side effects and concomitant treatment and, in addition, by reinforcing patients’ awareness of the importance of following the prescription schedule correctly. No conflict of interest.

Pharmacoeconomic considerations on treatment of multiple sclerosis: importance of computerisation and role of the daily dose received

Background In Italy, four parental formulations are currently approved for Multiple Sclerosis: interferon-β 1a (Avonex and Rebif), interferon-β 1b (Betaferon and Extavia) and glatiramer (Copaxone). In this study the appropriateness of the prescription, patient compliance and pharmacoeconomic profile were evaluated for each drug. Purpose The aim of this study was to test a particular database, FarmaDDSS, designed to follow patients through the hospital pharmacy where they receive the prescribed dose. This approach allows us to calculate important drug use parameters such as Received Daily Dose (RDD), Prescribed Daily Dose (PDD). Materials and methods In order to monitor prescriptions for drugs, a database was created, called ‘FarmaDDSS’, to enter drug use data such as RDD, PDD, appropriateness of the prescription, patient compliance and physician compliance. Economic considerations were made depending on the daily used dose of study drugs. The following data were loaded in the FarmaDDSS database: patient demographics, drug used, dosage and date of delivery of the drug. Results There were 117 patients in this four-year study. RDD and PDD and related costs were calculated for each drug. The RDD values, calculated over four years, between 2007 and 2010, for Avonex, Betaferon, Extavia, Rebif 22 and 44 were 4.65, 3.92, 19.75, 9.05 and 18.82, respectively. Appropriateness of the prescribing and patient compliance were approaching the figure 1, thus showing a good clinical profile for all drugs except for Rebif. Calculating the cost per RDD, the most expensive drug seems to be the Rebif with a cost of € 36.00 per day. Conclusions It is very important to use the RDD as parameter of pharmacoeconomic valuation because it represents a more reliable indicator than the DDD. In this case the computerisation plays an important role in following the patient, especially in this type of pathology.