Journal of managed care & specialty pharmacy
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J Manag Care Spec Pharm · Jul 2014
Comparative StudyMedication effectiveness with the use of tumor necrosis factor inhibitors among Texas Medicaid patients diagnosed with rheumatoid arthritis.
Adalimumab (Humira [ADA]), etanercept (Enbrel [ETN]), and infliximab (Remicade [IFX]) are tumor necrosis factor (TNF) inhibitors indicated for the treatment of a variety of disorders. While their effectiveness has not been directly compared in a clinical trial, results from the majority of the indirect treatment comparisons suggest comparable efficacy and safety profiles. However, these TNF inhibitor agents differ in administration method and dosing flexibility, which may result in differences in medication use profiles (e.g., adherence, persistence, discontinuation, dose escalation, and switching to a new biologic rheumatoid arthritis drug) and effectiveness in clinical practice. ⋯ The study results suggest that when using a medication effectiveness algorithm, IFX, ETN, and ADA have comparable effectiveness in patients with RA. Patient adherence to therapy may be higher if given IFX, and patients who receive ETN are less likely to have a dose escalation.
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J Manag Care Spec Pharm · Jul 2014
Comparative StudyMethodological considerations in estimating adherence and persistence for a long-acting injectable medication.
Measures of medication adherence and persistence are important for researchers and policymakers to assess quality of care. Lack of adherence has been associated with adverse outcomes and higher costs of care. Long-acting medication formulations, including injectable forms, have been proposed as interventions to increase adherence and in turn improve health outcomes and costs. Standard measures of adherence/persistence were developed for orally administered medications. Methods for assessing adherence/persistence of long-acting injectable dose forms are understudied. ⋯ Standard medication adherence/persistence measures yielded different conclusions when comparing a LA-SGA and an O-SGA, depending on the measure and underlying assumption for days supply. Adherence/persistence measures that address pharmacological differences in terms of formulation and duration of therapeutic drug levels between medications may be necessary and are particularly important as more injectable antipsychotic medications are approved in the United States. Therefore, payers and investigators should consider sensitivity analysis using different adherence/persistence definitions when making product comparisons to ensure confidence in conclusions.
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J Manag Care Spec Pharm · Jul 2014
Associations between statin adherence level, health care costs, and utilization.
Evidence of the associations between statin adherence level, health care costs, and utilization is still limited. It is not clear whether better clinical outcomes derived from increasing statin adherence levels can be translated into cost savings and lower health care utilization. ⋯ Our study results show that much higher statin adherence levels are related to fewer ER visits after statin treatment is taken for a year among beneficiaries; however, the study is inconclusive whether higher statin adherence levels are associated with lower overall health care costs in a year after statin therapy is taken. Further research is needed to evaluate the associations between statin adherence level, the cost of cardiovascular care alone, and utilization over a longer period.