Poor adherence to SLE medication predictive of higher Medicaid care costs

Lower adherence to immunosuppressive or antimalarial drugs in patients with systemic lupus erythematosus enrolled in Medicaid was shown to increase the risk for subsequent hospitalization and ED visits, according to research presented recently.

Medicaid data between 2000 and 2006 were used to identify 15,955 patients diagnosed with systemic lupus erythematosus (SLE). Patients’ mean age was 38.6 years; 95% of the patients were female, 39% were black, 34% were white, 16% were Hispanic, 5% were Asian, 5% were of other descent and 1% were American Indian. Patients were enrolled in Medicaid for at least 2 years and prescribed either an immunosuppressive drug (azathioprine, cyclophosphamide, leflunomide, methotrexate, mycophenolate, mycophenolic acid or tacrolimus) or antimalarial drug (hydroxychloroquine) filled at an outpatient pharmacy. Pharmacy records were studied to calculate a medication possession ratio (MPR) used to assess the likelihood of adherence.

Jinoos Yazdany

The researchers used the average MPR for SLE drugs in the baseline year to examine outcomes in the following year and included all-cause hospitalization, SLE-related hospitalizations and emergency department (ED) visits.

MPR during the baseline year was 49%. In the follow-up year, 28% had one or more hospitalizations, 17% SLE-related hospitalizations and 49% had ED visits.

After adjusting for age, sex, race/ethnicity Charlson comorbidity index, SLE-specific risk index and the number of SLE drugs taken, the researchers found lower adherence (less than 80%) was associated with a significantly increased risk for subsequent hospitalizations and ED visits. – by Shirley Pulawski

Reference:

Yazdany J, et al. Paper #903. Presented at: American College of Rheumatology Annual Meeting. Nov. 14-19, 2014; Boston.

Disclosure: The authors have no relevant financial disclosures.