Pulmonary medication adherence and health-care use in cystic fibrosis.
BACKGROUND
Poor treatment adherence is common in cystic fibrosis (CF) and may lead to worse health outcomes and greater health-care use. This study evaluated associations of adherence to pulmonary medications, age, health-care use, and cost among patients with CF.


METHODS
Patients with CF aged ≥ 6 years were identified in a national commercial claims database. A 12-month medication possession ratio (MPR) was computed for each pulmonary medication and then averaged for a composite MPR (CMPR) for each patient. The CMPR was categorized as low (< 0.50), moderate (0.50-0.80), or high (≥ 0.80). Annual health-care use and costs were measured during the first and second year and compared across adherence categories by multivariable modeling.


RESULTS
Mean CMPR for the sample (N = 3,287) was 48% ± 31%. Age was inversely related to CMPR. In the concurrent year, more CF-related hospitalizations were observed among patients with low (event rate ratio [ERR], 1.35; 95% CI, 1.15-1.57) and moderate (ERR, 1.25; 95% CI, 1.05-1.48) vs high adherence; similar associations were observed for all-cause hospitalizations and CF-related and all-cause acute care use (hospitalizations + ED) in the concurrent and subsequent year. Rates of CF-related and all-cause outpatient visits did not differ by adherence. Low and moderate adherence predicted higher concurrent health-care costs by $14,211 ($5,557-$24,371) and $8,493 (-$1,691 to $19,709), respectively, compared with high adherence.


CONCLUSIONS
Worse adherence to pulmonary medications was associated with higher acute health-care use in a national, privately insured cohort of patients with CF. Addressing adherence may reduce avoidable health-care use.
Department of Psychology, University of Miami, Coral Gables, FL. Electronic address: aquittner@miami.edu.
Alexandra L
AL
Quittner
Novartis Pharmaceuticals Corp, East Hanover, NJ.
Jie
J
Zhang
Analysis Group, Inc, Boston, MA.
Maryna
M
Marynchenko
Analysis Group, Inc, Boston, MA.
Pooja A
PA
Chopra
Analysis Group, Inc, Boston, MA.
James
J
Signorovitch
Analysis Group, Inc, Boston, MA.
Yana
Y
Yushkina
Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.
Kristin A
KA
Riekert
D000293:Adolescent; D000328:Adult; D002648:Child; D003550:Cystic Fibrosis / Q000188:drug therapy* / Q000191:economics; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000639:trends*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence; D010349:Patient Compliance; D012189:Retrospective Studies; D055815:Young Adult
D007166:Immunosuppressive Agents