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Infliximab therapy adherence differences by site of care among patients with inflammatory bowel disease

2014; Elsevier BV; Volume: 17; Issue: 3 Linguagem: Inglês

10.1016/j.jval.2014.03.234

1524-4733

A. Khetia, Jennifer H. Lofland, William H. Olson, George J. Wan, Terra Slaton, Chris M Kozma,

Pregnancy and Medication Impact

To examine the association between adherence and site of care among individuals with inflammatory bowel disease (IBD) treated with infliximab. Adult patients with new claim(s) for infliximab (no claims for at least 360 days) between January 1, 2006 to December 31, 2009 and ≥2 IBD diagnoses of Crohn’s disease (CD; ICD-9-CM: 555.XX) or ulcerative colitis (UC; ICD-9-CM: 556.XX) were identified from Thomas Reuters Marketscan® Databases. Patients were required to be continuously enrolled for 12 months before and after infliximab initiation (index date). Patients with evidence of another biologic or rheumatoid arthritis (ICD-9-CM: 714.XX) were excluded. Being adherent was defined as having an infliximab medication possession ratio (MPR) of ≥80%. MPR was calculated as the sum of unduplicated days of therapy based on infusion dates and duration of action from prescribing information, divided by 360 days. Site of care was obtained from the first infliximab infusion claim. Sites were divided into three settings: office, outpatient hospital and “other” (e.g., home, ER). Odds of being adherent versus non-adherent were compared for these settings in a logistic model controlling for patient characteristics and resource use variables. 1646 IBD patients were identified; 57.4% CD and 42.6% UC. The mean (SD) age was 44.4 (15.6) years and 51.7% were male. On index, 1,052 (63.9%) patients had a site of care for office on their first infliximab infusion claim, 510 (31.0%) had outpatient hospital, and 84 (5.1%) had “other”. Patients in the office setting had greater odds of being adherent relative to outpatient hospital (p<0.0001; OR 2.5, 95% CI [1.9, 3.2]) and ‘other’ (p=0.0039; OR 2.1, 95% CI [1.3, 3.4]). Outpatient hospital was not significantly different than the ‘other’ location (p=0.5204). Findings suggest that having an office site of care is associated with increased infliximab adherence relative to the outpatient hospital setting.