title: A retrospective managed care claims data analysis of medication adherence to vaginal estrogen therapy: implications for clinical practice.
abstract: OBJECTIVE
  This study sought to assess refill-based treatment duration and adherence to vaginal estrogen therapy (VET) in clinical practice and to compare treatment duration in women prescribed vaginal tablets (VT) or vaginal creams (VC) in clinical trials with that in clinical practice.
  
  
  METHODS
  Adults initiating VET between January and June 2004 were identified in 57 commercial health plans in the United States and followed for up to 10 months after treatment initiation. Treatment duration (Kaplan-Meier analysis) and adherence (medication possession ratio [MPR]) were examined for VC and VT cohorts and compared with a weighted average of treatment duration calculated for seven clinical trials identified in the literature.
  
  
  RESULTS
  Of 13,074 women (mean age 54 +/- 9.1 years) identified, patients on VT had significantly longer treatment duration compared with patients on VC (149.1 +/- 101.1 days vs. 91.6 +/- 30.0 days, p < 0.01). Among 5,599 patients receiving multiple prescriptions, higher treatment durations were observed for both VT-treated and VC-treated patients (198.5 +/- 82.4 days vs. 177.1 +/- 86.7 days, p < 0.01) compared with 165 days observed in clinical trials. Medication adherence (MPR > or = 80%) was significantly higher among VT users compared with VC users (74% +/- 27% vs. 52% +/- 32%], p < 0.01); OR, 3.24, 95% CI 2.84-3.70).
  
  
  CONCLUSIONS
  Duration of VET among patients receiving multiple prescriptions was longer in real-world clinical practice than in clinical trials. Newly treated patients initiating VT were more likely to continue treatment for longer periods and exhibited greater medication adherence than did those on VC.
authors.affiliation: Division of Reproductive Genetics, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
authors.forename: Lee P
authors.initials: LP
authors.lastname: Shulman
authors.forename: David J
authors.initials: DJ
authors.lastname: Portman
authors.forename: Won Chan
authors.initials: WC
authors.lastname: Lee
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Balu
authors.forename: Ashish V
authors.initials: AV
authors.lastname: Joshi
authors.forename: David
authors.initials: D
authors.lastname: Cobden
authors.forename: Qin
authors.initials: Q
authors.lastname: Wang
authors.forename: Chris L
authors.initials: CL
authors.lastname: Pashos
mesh_terms: D000282:Administration, Intravaginal; D000368:Aged; D015331:Cohort Studies; D004958:Estradiol / Q000008:administration & dosage; D015914:Estrogen Replacement Therapy / Q000379:methods*; D004967:Estrogens / Q000008:administration & dosage*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012646:Self Administration / Q000706:statistics & numerical data; D013607:Tablets / Q000008:administration & dosage*; D014481:United States; D014622:Vaginal Creams, Foams, and Jellies / Q000008:administration & dosage*; D016387:Women's Health
chemical_list: D004967:Estrogens; D013607:Tablets; D014622:Vaginal Creams, Foams, and Jellies; D004958:Estradiol