title: Persistence and adherence with urinary antispasmodic medications among employees and the impact of adherence on costs and absenteeism.
abstract: BACKGROUND
  Overactive bladder (OAB) and related conditions, such as urge urinary incontinence (UI), can interfere with work, leisure activities, and healthy sleep patterns.
  
  
  OBJECTIVE
  To report (a) employee urinary antispasmodic (UA) medication persistence and adherence; (b) the impact of salary and copay on adherence; and (c) the impact of UA adherence on medical, pharmacy, sick leave (SL), short- and long-term disability (STD, LTD), workers' compensation costs, work absence days, and turnover.
  
  
  METHODS
  This retrospective study used a 2001-2011 database of claims, payroll, and demographic data from 27 large U.S. employers. Employees aged 18-64 years taking UA medications with health plan enrollment from 6 months before the index UA medication prescription to 12 months after were included. Persistence (days until first ≥ 30-day gap in UA medication supply) and adherence (percentage of the annual post-index period with available medication) were assessed using survival analysis and generalized linear regression models that controlled for demographics, job-related factors, copay, and pre-index employee benefit utilization.
  
  
  RESULTS
  2,960 employees met study criteria. Median days of persistence by OAB subtype were 76, 82, 43, 66, and 60 for urge UI, mixed UI, nocturnal UI, other OAB, and no diagnosis, respectively (P  less than  0.05 for urge and mixed vs. no diagnosis). Increased copay and copay as a percentage of salary were associated with lower adherence. Employees with ≥ 80% adherence had lower medical, SL, and STD and higher overall drug costs than employees with less than  80% adherence.
  
  
  CONCLUSIONS
  This study suggests potential economic benefits to employers from increased UA adherence. Additionally, economic factors such as ability to pay influence adherence to UA medications.
authors.affiliation: HCMS Group LLC, 415 W. 17th St., Ste. 250, Cheyenne, WY 82001, USA. nathan_kleinman@hcmsgroup.com.
authors.forename: Nathan L
authors.initials: NL
authors.lastname: Kleinman
authors.forename: Kevin
authors.initials: K
authors.lastname: Odell
authors.forename: Chieh-I
authors.initials: CI
authors.lastname: Chen
authors.forename: Amy
authors.initials: A
authors.lastname: Atkinson
authors.forename: Kelly H
authors.initials: KH
authors.lastname: Zou
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D017047:Cost Sharing / Q000191:economics; D016208:Databases, Factual; D016527:Drug Costs; D005260:Female; D006264:Health Benefit Plans, Employee / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010276:Parasympatholytics / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D012189:Retrospective Studies; D012456:Salaries and Fringe Benefits / Q000706:statistics & numerical data; D018582:Sick Leave / Q000191:economics; D013997:Time Factors; D014481:United States; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000191:economics; D053202:Urinary Incontinence, Urge / Q000188:drug therapy* / Q000191:economics; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D010276:Parasympatholytics