Pulmonary medication adherence and health-care use in cystic fibrosis

Alexandra L. Quittner, Jie Zhang, Maryna Marynchenko, Pooja A. Chopra, James Signorovitch, Yana Yushkina, Kristin A. Riekert

Research output: Contribution to journalArticle

109 Scopus citations

Abstract

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. R ESULTS: 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 1 ED ) in the concurrent and subsequent year. Rates of CF-related and all-cause outpatient visits did not diff er by adherence. Low and moderate adherence predicted higher concurrent health-care costs by $14,211 ($5,557-$24,371) and $8,493 ( 2 $1,691 to $19,709 ), respectively, compared with high adherence. C ONCLUSIONS: 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.

Original languageEnglish (US)
Pages (from-to)142-151
Number of pages10
JournalCHEST
Volume146
Issue number1
DOIs
StatePublished - Jul 2014

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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    Quittner, A. L., Zhang, J., Marynchenko, M., Chopra, P. A., Signorovitch, J., Yushkina, Y., & Riekert, K. A. (2014). Pulmonary medication adherence and health-care use in cystic fibrosis. CHEST, 146(1), 142-151. https://doi.org/10.1378/chest.13-1926