Abstract
Background: Adherence to inhaled medication regimens affects chronic obstructive pulmonary disease (COPD) prognosis and quality of life, and reduces the use of healthcare services, resulting in cost savings. Objectives: To examine the effects of adherence to inhaled medication regimens on healthcare utilization and costs in high-grade COPD patients. Methods: We performed an observational retrospective cohort study using a longitudinal data set from the Korean Health Insurance Review and Assessment Service (2008–2013) containing healthcare services’ information for 50 million beneficiaries. The study population was high-grade COPD patients. “Adherent” was defined as a patient attaining a medication possession ratio (MPR) ≥ 80%. We estimated the effects of adherence on the use of intensive care units (ICUs) and emergency rooms (ERs) using a multivariate logistic regression, and estimated the effects on costs (all-cause and COPD-related) using a generalized linear model, with adjustment for patient sociodemographic characteristics, health status, and comorbidities. Results: Of 9086 high-grade COPD patients, adherence declined from 34.7 to 22.3% over 4 years. Adherence was inversely associated with use of ICUs and costs, and this association got stronger as the adherence period lengthened. Over the 4-year period, the adherent group had a lower likelihood of using ICUs [odds ratio (OR) = 0.74, 95% confidence interval (CI) 0.60–0.91] than the non-adherent group. Similarly, the adherent group had a 10.4% lower all-cause cost (p < 0.001) and an 11.7% lower COPD-related cost (p < 0.0001) versus the non-adherent group. Conclusions: Adherence reduces healthcare utilization and costs, so adherence is not only clinically effective but also economically efficient. However, less than one-quarter of this population remained adherent over the 4-year period, suggesting that strategies are needed to improve adherence.
| Original language | English |
|---|---|
| Pages (from-to) | 333-340 |
| Number of pages | 8 |
| Journal | Clinical Drug Investigation |
| Volume | 38 |
| Issue number | 4 |
| DOIs | |
| State | Published - 1 Apr 2018 |
Bibliographical note
Funding Information:This study was conducted as a part of the project “Trends in medication utilization and adherence to medication among patients with chronic conditions: the case of COPD” by HIRA. CK Rhee received consulting/lecture fees from MSD, AstraZeneca, Novartis, GSK, Takeda, Mundipharma, Sandoz, Boehringer-Ingelheim, and Teva-Handok. Other authors have no competing interests to disclose. No funding was provided for this study.
Publisher Copyright:
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