title: Association between oral 5-ASA adherence and health care utilization and costs among patients with active ulcerative colitis.
abstract: BACKGROUND
  Observational cohort study to assess the association between adherence to oral 5-aminosalicylates (5-ASAs) and all-cause costs and health care utilization among patients with active ulcerative colitis (UC) in the United States.
  
  
  METHODS
  Retrospective analysis of insurance claims from June 1997 to August 2006 in the LifeLink Database. Patient criteria: aged 18 or older with one or more claim(s) between June 1997 and August 2005 for a UC diagnosis and at least one oral 5-ASA prescription on or after the first observed UC diagnosis; continuous enrollment for at least 6 months prior to and 12 months following 5-ASA initiation (index date). As a proxy for active disease, patients needed to have at least two UC-specific non-pharmacy claims, at least 30 days of 5-ASA treatment and at least one corticosteroid prescription within the 12-month post-index period. Cumulative exposure to oral 5-ASAs over the 12-month period was calculated using the medication possession ratio (MPR). Patients with an MPR of at least 0.80 were classified as adherent. All-cause medical and pharmacy resource utilization and costs were computed over the 12-month post-index period and compared between adherent and nonadherent patients.
  
  
  RESULTS
  1,693 UC patients met study inclusion criteria: 72% were nonadherent to 5-ASA treatment (n=1,217) and 28% were adherent (n=476) in the 12-month study period. Compared with nonadherent patients, adherent patients had 31% fewer hospitalizations (P=0.0025) and 34% fewer emergency department admissions (P=0.0016). Adherent patients had 25% more pharmacy prescriptions overall (P <0.0001) and 71% more UC-related pharmacy prescriptions (P <0.0001) than did nonadherent patients. Total all-cause health care utilization was 1.13 times higher for adherent patients than for nonadherent patients (P=0.0002). After adjusting for covariates, total all-cause costs were 29% higher for nonadherent patients than for adherent patients (mean [95% confidence interval]: $13,465 [$13,094, $13,835] vs $17,339 [$17,033, $17,645]).
  
  
  CONCLUSIONS
  Approximately three-quarters of patients with active UC were not adherent with their prescribed doses of oral 5-ASA. Nonadherence was associated with higher total all-cause costs. The key driver of decreased costs among adherent patients was inpatient hospitalizations, which more than offset these patients' expected higher pharmacy costs.
authors.affiliation: RTI Health Solutions, 3040 Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC, 27709-2194, USA. mitra@rti.org
authors.forename: Debanjali
authors.initials: D
authors.lastname: Mitra
authors.forename: Paul
authors.initials: P
authors.lastname: Hodgkins
authors.forename: Linnette
authors.initials: L
authors.lastname: Yen
authors.forename: Keith L
authors.initials: KL
authors.lastname: Davis
authors.forename: Russell D
authors.initials: RD
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000191:economics*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use*; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D019804:Mesalamine