Chest
Original ResearchGenetic and Developmental DisordersPulmonary Medication Adherence and Health-care Use in Cystic Fibrosis
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Data Source and Sample Selection
The Thomson Reuters MarketScan Commercial Claims and Encounters Database (January 2005 to June 2011) includes medical and drug data for active employees and their dependents with primary coverage through employer-sponsored private health insurance throughout the United States.18 The MarketScan claims database offers the largest claims capture of physician office visits; hospital stays; retail, mail-order, and specialty pharmacies; and carve-out care. The database undergoes extensive validity
Patient Characteristics
The study sample included 3,287 patients with CF (Table 1). Mean age was 22.8 ± 13.0 years, and female patients comprised 49% of the sample (Table 2). The demographic characteristics of the present sample were comparable to the general CF population as reported in the Cystic Fibrosis Registry1; however, the present sample included more adults (age ≥ 18 years, 56% vs 48%) and more patients with Pseudomonas aeruginosa infection (63.0% vs 51%). A subgroup of 1,420 patients had continuous
Discussion
This retrospective analysis used administrative claims data from a large, nationwide database to evaluate the relationship between overall long-term pulmonary medication adherence and demographic variables, health-care use, and health-care costs among patients with CF. About one-half of the sampled patients filled less than one-half of their medications, which is consistent with adherence rates seen in other chronic illnesses.19 Adherence over a 1-year period, categorized as low (CMPR < 0.50),
Conclusions
Achieving and maintaining adherence to long-term pulmonary therapy is critically important to the effective management of CF. This study found that rates of adherence to long-term CF pulmonary medications, using 12-month CMPRs, were significant predictors of subsequent health-care use and costs in a national sample of patients with CF. Adherence to long-term pulmonary medications was quite low (< 50%) and differed systematically across age and sex. Additional research is needed to understand
Acknowledgments
Author contributions: J. S. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. A. L. Q., J. Z., M. M., P. A. C., J. S., and K. A. R. contributed to the study conception and design; A. L. Q., J. Z., M. M., P. A. C., J. S., and K. A. R. contributed to data interpretation; M. M., P. A. C., J. S., and Y. Y. contributed to data analysis; A. L. Q., M. M., P. A. C., and K. A. R. contributed to the writing of the
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Parts of this study have been reported in abstract form at the 26th Annual North American Cystic Fibrosis Conference, October 11-13, 2012, Orlando, FL.
FUNDING/SUPPORT: This study was supported by the Novartis Pharmaceuticals Corp, which manufactures inhaled tobramycin.
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