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Nonadherence to 5-ASAs for ulcerative colitis occurred often, raised health care costs
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Most patients with ulcerative colitis treated with 5-aminosalicylic acid were nonadherent to treatment and had elevated health care costs compared with adherent patients in a recent study.
In an observational cohort study, researchers performed retrospective analysis on insurance claims from 1,693 patients with ulcerative colitis (UC) between June 1997 and August 2006. All participants had received one or more prescriptions for oral 5-aminosalicylic acid (5-ASA) at or after UC diagnosis. Within 12 months of 5-ASA initiation, all patients made two or more UC-related nonpharmacy claims, received 30 or more days of 5-ASA treatment, and had one or more prescriptions for corticosteroids.
Medication adherence was measured according to the medication possession ratio (MPR): the number of days’ 5-ASA supply provided to each patient during 12 months of follow-up, divided by 365 days. An MPR value below 0.8 was considered nonadherence. Health care costs were calculated from a third-party payer perspective and did not include out-of-pocket expenses.
The majority of participants (72%) did not adhere to 5-ASA treatment during the study, with a mean MPR of 0.54 for the entire cohort, 0.90 for adherent and 0.40 for nonadherent participants. Adherent patients were less likely to be hospitalized (IRR=0.6928; P=.0025) or admitted to an ER (IRR=0.6584; P=.0016), and also had a greater number of both UC-specific and overall prescriptions (P<.0001 for both).
After adjusting for covariates, predicted costs for prescriptions were significantly higher among adherent patients both overall (mean $5,310 vs. $3,190) and for UC-specific treatments (mean $3,569 vs. $1,718). Costs related to hospitalizations were higher among nonadherent patients (mean $28,727 compared with $14,542), as were overall health care costs (mean $17,339 compared with $13,465) (P<.0001 for all).
“This study finds adherence to oral 5-ASAs to be suboptimal, and that patients who are nonadherent to therapy have greater health care costs,” the researchers wrote. “Efforts to promote oral 5-ASA adherence in patients with UC may lead to cost savings for third-party payers and other stakeholders.”
Disclosure: See the study for a full list of relevant disclosures.
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