title: Is the level of patient co-payment for medicines associated with refill adherence in Sweden?
abstract: BACKGROUND
  In the Swedish reimbursement scheme, the co-payment is based on the price of the product and decreases in a stepwise manner as the total accumulated co-payment increases. The aim of this study was to analyse how refill adherence in Sweden varies according to patient's co-payment level for medicines, with antiepileptic drug (AED) use as an example.
  
  
  METHODS
  Prevalent AED users aged 18-85 years who purchased an AED between 1 January and 30 June 2007 were identified in the Swedish Prescribed Drug Register and followed for a maximum of 2 years. Patient time was categorized based on patient's accumulated co-payment for all drugs per reimbursement period. The continuous measure of medication acquisition (CMA) was used to estimate refill adherence in relation to the patients' co-payment level. Associations between patients' co-payment for all medicines and refill adherence were assessed with multilevel mixed-effects linear regression, accounting for clustering within patients.
  
  
  RESULTS
  The study population included 2210 patients (mean age: 56 years; 54% men). CMA for AED was 91% for patients where the co-payment corresponded to 100% of the price. Compared with these patients, refill adherence for AED was 2-4% higher (P < 0.001) for patients with reduced co-payment (co-payment of ≤50% of the price). Higher age, higher income and fenytoin use were also associated with a higher refill adherence for AED.
  
  
  CONCLUSIONS
  Using AED as an example, a higher level of reimbursement was associated with a higher refill adherence compared with full co-payment in Sweden.
authors.affiliation: 1 Nordic School of Public Health, Gothenburg, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Lesén
authors.forename: Karolina
authors.initials: K
authors.lastname: Andersson Sundell
authors.forename: Anders
authors.initials: A
authors.lastname: Carlsten
authors.forename: Ann-Charlotte
authors.initials: AC
authors.lastname: Mårdby
authors.forename: Anna K
authors.initials: AK
authors.lastname: Jönsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003669:Deductibles and Coinsurance / Q000706:statistics & numerical data*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012042:Registries; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult; D016903:Drug Monitoring