Adherence, Persistence, Healthcare Utilization, and Cost Benefits of Guideline-R

StephenW

J Med Econ. 2012 Jul 10. [Epub ahead of print]
Adherence, Persistence, Healthcare Utilization, and Cost Benefits of Guideline-Recommended Hepatitis B Pharmacotherapy.Han SH, Jing W, Mena E, Li M, Pinsky B, Tang H, Hebden T, Juday T.
AbstractAbstract
OBJECTIVE: To compare pharmacotherapy adherence, persistence, and healthcare utilization/costs among US patients with chronic hepatitis B (CHB) initiated on an oral antiviral monotherapy recommended as first-line treatment by current national (US) guidelines versus an oral antiviral not recommended as first-line monotherapy.
RESEARCH DESIGN AND METHODS: In this retrospective cohort study, patients aged 18-64 with medical claims for CHB who initiated an oral antiviral monotherapy for CHB between 07/01/05 and 1/31/10 were identified from a large US commercial health insurance claims database. Patients were continuously enrolled for a 6-month baseline period and ≥90 days follow-up. They were assigned to "currently recommended first-line therapy" (RT: entecavir or tenofovir) or "not currently recommended first-line therapy" (NRT: lamivudine, telbivudine, or adefovir) cohorts.
MAIN OUTCOME MEASURES: Multivariate analyses were conducted to compare treatment adherence, persistence, healthcare utilization, and costs for RT versus NRT cohorts.
RESULTS: Baseline characteristics were similar between RT (N=825) and NRT (N=916) cohorts. In multivariate analyses, RT patients were twice as likely as NRT patients to be adherent (OR=2.09; p<0.01) and persistent (mean: RT=361 days, NRT=298 days; p<0.01), and half as likely to have an inpatient stay (OR=0.527; p<0.01). Between the two oral antivirals recommended as first-line treatment, even though pharmacy cost was higher for entecavir, mean total healthcare costs for entecavir and tenofovir were similar ($1214 and $1332 per patient per month, respectively). Similar results were also observed with regard to adherence, persistence, and healthcare use for entecavir and tenofovir.
CONCLUSIONS: A limitation associated with analysis of administrative claims data is that coding errors can be mitigated but are typically not fully eradicated by careful study design. Nevertheless, the current findings clearly indicate the benefits of initiating CHB treatment with an oral antiviral monotherapy recommended as first-line treatment by current guidelines.

StephenW

J MED经济学。 2012年七月10。 [出处提前打印]
坚持，坚持，医疗利用，并指引推荐的B型肝炎药物治疗的成​​本优势。
韩SH，靖伟，梅纳é，李明，平斯基唐ĤHebden牛逼，Juday吨
抽象

抽象
目的：

药物治疗依从性，持久性，医疗利用/成本之间进行比较美国与慢性乙型肝炎（CHB）由现行的国家（美国）的指导方针与建议作为第一线治疗的口服抗病毒药物单一发起患者口服抗病毒药物不建议作为第一线单一。
研究设计和方法：

与慢性乙型肝炎的医疗索赔05年7月1日和10年1月31日之间的口头单药治疗慢性乙型肝炎的抗病毒药物是谁发起的18-64岁的患者在此回顾性队列研究，确定了由美国一家大型商业健康保险索赔数据库。患者连续参加6个月的基线期和≥90天的后续行动。他们被分配到“目前建议的第一线疗法”（RT：恩替卡韦或替诺福韦）或“目前不推荐的第一线疗法”（NRT：拉米夫定，替比夫定，或阿德福韦）同伙。
主要观察指标：

多元进行了分析比较治疗依从性，持久性，医疗利用，成本为RT与净吨同伙。
结果：

RT（n = 825）和尼古丁替代疗法（n = 916）同伙之间的基线特征相似。在多变量分析，RT患者的两倍，可能是尼古丁替代疗法的患者粘附（OR = 2.09; P <0.01）和持久性（平均为：RT = 361天，净吨= 298天; P <0.01），一半可能住院病人住院时间（OR = 0.527，P <0.01）。之间的两种口服抗病毒药物，作为第一线治疗建议制药成本，即使是高恩替卡韦，恩替卡韦和替诺福韦的总医疗费用相似（1214美元的每月1332美元每名患者，分别）。坚持，持久性，使用恩替卡韦和替诺福韦和医疗方面也观察到了类似的结果。
结论：

行政索赔数据分析相关的限制是可以得到缓解，但编码错误通常不会完全根除仔细研究设计。然而，目前的研究结果清楚地表明发起，由目前的指引建议作为第一线治疗的口服抗病毒药物单一的慢性乙型肝炎治疗的好处。