Treatment persistence and adherence and their consequences on patient outcomes of generic versus brand-name statins routinely used to treat high cholesterol levels in Spain: a retrospective cost-consequences analysis.

BACKGROUND: High blood lipoprotein concentrations are one of the major risk factors for cardiovascular diseases. Drug therapy is the base of treatment; statins in particular. Both brand-name and generic presentations are available for statin therapy of high cholesterol levels. Factors that may influence their use in routine medical practice include, among others, patient persistence and adherence to treatment as prescribed by physicians. The aim of this retrospective analysis was to provide real-world evidence of treatment persistence and adherence and their consequences on economic and patient outcomes of generic versus brand-name statins routinely used to treat high cholesterol levels in Spain. METHODS: Existing real-world electronic medical records abstracted from a database of two regions in Spain were analyzed. The analysis compared generic versus brand-name statins data from subjects' who started treatment between July 1, 2010 and June 30, 2012. Treatment persistence, adherence expressed as medication possession ratio (MPR), healthcare resource utilization and their costs were analyzed together with patient's at-goal rates of low-density-lipoprotein-cholesterol (LDL-c), incidence of any major cardiovascular event (CVE) and all-cause mortality during a 5-year follow-up period. Multivariate analyses were applied. RESULTS: A total of 13,244 records were included. Persistence was lower with generics; adjusted hazard ratio -HR- [95% confidence interval]: 0.86 [0.82-0.91], p < 0.001) and MPR was also lower: 61.5% vs. 65.1% (p < 0.001). Less patients with generics reached their LDL-c goal: 39.2% [38.3-40.2%] vs. 42.0% [40.2-43.7%]; adjusted odds ratio; 0.87 [0.80-0.95], p = 0.003. Compared to brand-name statins, the observed probability of occurrence of a CVE; HR: 1.31 [1.15-1.50], p < 0.001, and also all-cause deaths; HR: 1.36 [1.15-1.62], was significantly higher with generics; p < 0.001 in both cases. Adjusted mean total healthcare cost per patient was also higher with generic than with brand-name statins: €9118 (9059-9176) vs. €7980 (7853-8808) [adjusted difference: €1137 (997-1277), p < 0.001]. CONCLUSION: This retrospective cost-consequences analysis found poorer treatment persistence and adherence in patients who first started therapy with generic instead of brand-name statins in routine medical practice in Spain. Also, patients receiving generics were more unlikely to reach LDL-c goals, showed increased probability of having CVE and all-cause mortality at a higher cost to payers.

Persistencia al tratamiento y uso de recursos con corticosteroides y agonistas ß-adrenérgicos de larga duración inhalados a dosis fijas para el tratamiento del asma: estudio retrospectivo de base poblacional / Persistence to treatment and resources use with inhaled fixed-dose combinations of corticosteroids and long-acting ß-adrenergic agonists for the treatment of asthma: A population-based retrospective study

Objetivo: Determinar la persistencia, las exacerbaciones y el uso de los recursos en los pacientes que inician tratamiento inhalador con fluticasona propionato/formoterol (PF/Form) con relación a otras combinaciones de corticoide inhalado/agonista ß-adrenérgico de larga duración (CI/LABA) en dosis fijas, para el tratamiento del asma en condiciones de práctica clínica habitual. Material y métodos: Estudio observacional realizado a partir de la revisión de registros médicos. Se incluyeron sujetos ≥18 años que iniciaron tratamiento con CI/LABA y que cumplieran con determinados criterios de inclusión/exclusión. El seguimiento se realizó durante un año. Grupos de estudio: a) PF/Form y b) otras-combinaciones (Otros-CI/LABA). Principales medidas: persistencia, ratio posesión del medicamento (RPM), exacerbaciones y costes (directos/indirectos). El análisis estadístico se elaboró mediante modelos de regresión, con p <0,05. Resultados: Se seleccionó a 3.203 pacientes. Por grupos: a) PF/Form: 7,0% y b) Otros-CI/LABA: 93,0%. La edad media fue de 52,2 años y el 60,8% fueron mujeres. El 44,9% de los pacientes presentaban un asma persistente-moderado. Los pacientes en tratamiento con PF/Form se asociaron a una mayor persistencia (67,6 vs. 61,2%; p=0,043), mayor RPM (80,6 vs. 74,3%; p=0,002) y menores exacerbaciones (16,0 vs. 21,9%; p=0,021), especialmente exacerbaciones severas (4,0 vs. 7,7%; p=0,043). El promedio/unitario del coste total (ANCOVA) fue menor en los pacientes en tratamiento con PF/Form (2.033 vs. 2.486 €; p=0,012), respectivamente. El coste total se asoció a exacerbaciones (ß = 0,618), severidad-asma (ß = 0,214), edad (ß = 0,073) y falta de adherencia (RPM: ß = −0,031), con p <0,01. Conclusiones: Los pacientes en tratamiento con PF/Form se asociaron a una mayor adherencia al tratamiento (persistencia, RPM), circunstancia que repercute en menores exacerbaciones severas y costes totales para el sistema nacional de salud. Estas diferencias podrían ser debidas a las propiedades farmacológicas del fármaco o a otros factores no medidos

Objective: To determine the persistence, exacerbations, and use of resources in patients who use inhaler treatment with fluticasone propionate/formoterol (PF/Form) in relation with other combinations of inhaled corticosteroid/long-acting ß-adrenergic (ICS/LABA) at fixed doses, for the treatment of asthma in real-life practice. Material and methods: Observational study conducted by reviewing medical records. The study included subjects ≥18 years of age who started treatment with ICS/LABA and who met certain inclusion/exclusion criteria. The follow-up was carried out for one year. Study groups: a) PF/Form and b) Other-combinations (Other-ICS/LABA). Main measurements: Persistence, medication possession ratio (MPR), exacerbations, and costs (direct/indirect). The statistical analysis was performed using regression models, with a P<.05. Results: A total of 3,203 patients were included in the study. By groups: a) FP/Form: 7.0% and b) Other-ICS/LABA: 93.0%. The mean age was 52.2 years, and 60.8% were women. A total of 44.9% of patients had persistent-moderate asthma. Patients under treatment with FP/Form were associated with greater persistence (67.6 vs. 61.2%, P=.043), a higher RPM (80.6 vs. 74.3%, P=.002), and less exacerbations (16.0 vs. 21.9%, P=.021), particularly severe-exacerbations (4.0 vs. 7.7%, P=.043). The mean/unit of the total cost (ANCOVA) was lower in patients under treatment with PF/Form (2,033 vs. € 2,486, P=.012), respectively. The total cost was associated with: Exacerbations (ß=0.618), asthma-severity (ß=0.214), age (ß=0.073), and lack-adherence (RPM: ß=−0.031), P<.01. Conclusions: Patients undergoing treatment with PF/Form were associated with greater adherence to treatment (persistence, RPM), a circumstance that leads to less severe exacerbations and total costs for the national health system. These differences could be due to the pharmacological properties of the drug or other factors not measured

Efecto de la edad y el género sobre las consecuencias clínicas y económicas del tratamiento con especialidad farmacéutica de marca o genérica en pacientes con dolor neuropático periférico en práctica clínica habitual / Clinical and economic consequences of treating patients with peripheral neuropathic pain with brand name or generic drugs in routine clinical practice: The effects of age and sex

OBJETIVO: Analizar el efecto de la edad y el género sobre el dolor y los costes en pacientes con dolor neuropático periférico (DNp) crónico que inician tratamiento con gabapentina (marca) frente a gabapentina genérica (EFG). MÉTODOS: Estudio multicéntrico-retrospectivo, realizado con registros médicos electrónicos (RME) de pacientes de ambos géneros, > 18años, que iniciaron nuevo tratamiento con gabapentina de marca o genérico. Durante un año se midió la adherencia (ratio posesión medicación [RPM]) y la persistencia, la utilización de recursos sanitarios, los costes y la reducción del dolor. RESULTADOS: Se analizaron 1.369 RME (61,1% mujeres; edad 64,6 [15,9] años, 52,4% ≥ 65 años); marca: 400, EFG: 969. La persistencia y la adherencia fueron mayores con marca: 7,3 vs. 6,3 meses (p < 0,001) y 86,5 vs. 81,3% de RPM (p < 0,001). Con marca, se observaron costes sanitarios menores, tanto en < 65 como en ≥ 65años (diferencias medias por paciente de 221 Euros [IC95%: 59-382] y de 217 Euros [51-382], respectivamente [p < 0,01]), como en hombres (diferencias medias de 197 Euros [63-328]) o mujeres (diferencias de 239 Euros [96-397]), p = 0,005 y p = 0,004, respectivamente. Comparado con EFG, el tratamiento con marca mostró una reducción mayor del dolor: 13,5% (10,9-16,2) y 10,8% (8,2-13,5) en < 65 y ≥ 65 años, respectivamente (p < 0,001), así como del 10,7% (8,2-13,2) y del 13,8% (11,0-16,5) en mujeres y hombres, respectivamente (p < 0,001). CONCLUSIONES: Con independencia del género o la edad, los pacientes que iniciaron tratamiento del DNp con gabapentina de marca vs. genérico mostraron un mayor grado de adherencia y persistencia al tratamiento, repercutiendo en unos menores costes sanitarios, a la vez que se observaron mayores reducciones del dolor

OBJECTIVE: We aimed to analyse the effects of age and sex on pain and cost for patients with chronic peripheral neuropathic pain (PNP) who have started treatment with brand name gabapentin versus generic gabapentin (EFG). METHODS: We conducted a retrospective multicentre study using electronic medical records (EMR) for patients of both sexes, older than 18, who began treatment with brand name or generic gabapentin. Adherence (medication possession ratio [MPR]), persistence, use of healthcare resources, cost, and pain reduction were measured for one year. RESULTS: We analysed 1369 EMRs [61.1% women; mean age 64.6 (15.9), 52.4% ≥ 65 years]; 400 used brand name drugs while 969 used generic gabapentin. Persistence and adherence were higher in patients using brand name gabapentin (7.3 vs 6.3 months, P < .001; 86.5% vs 81.3% MPR, P < .001). Lower healthcare costs were observed in patients using brand-name gabapentin in both age groups (< 65 and ≥ 65). Mean difference in cost per patient amounted to Euros221 (95%CI: 59-382) and Euros 217 (95%CI: 51-382) in the < 65 and ≥ 65 age groups, respectively (P < .01). Mean difference in cost among men amounted to Euros 197 (63-328), while mean difference in cost among women amounted to Euros 239 (96-397) (P = .005 and P = .004, respectively). Compared with EFG, brand treatment showed greater pain relief: 13.5% (10.9-16.2) and 10.8% (8.2-13.5) in < 65 and ≥ 65year patients, respectively (P < .001), and 10.7% (8.2-13.2) and 13.8% (11.0-16.5) in women and men respectively (P < .001). CONCLUSIONS: Regardless of sex and age, patients who started PNP treatment with brand name medication showed greater persistence and adherence to treatment than those taking generic drugs. Brand name treatment also involved lower healthcare costs, and greater pain relief

[Persistence to treatment and resources use with inhaled fixed-dose combinations of corticosteroids and long-acting ß-adrenergic agonists for the treatment of asthma: A population-based retrospective study]. / Persistencia al tratamiento y uso de recursos con corticosteroides y agonistas ß-adrenérgicos de larga duración inhalados a dosis fijas para el tratamiento del asma: estudio retrospectivo de base poblacional.

OBJECTIVE: To determine the persistence, exacerbations, and use of resources in patients who use inhaler treatment with fluticasone propionate/formoterol (PF/Form) in relation with other combinations of inhaled corticosteroid/long-acting ß-adrenergic (ICS/LABA) at fixed doses, for the treatment of asthma in real-life practice. MATERIAL AND METHODS: Observational study conducted by reviewing medical records. The study included subjects ≥18 years of age who started treatment with ICS/LABA and who met certain inclusion/exclusion criteria. The follow-up was carried out for one year. Study groups: a) PF/Form and b) Other-combinations (Other-ICS/LABA). MAIN MEASUREMENTS: Persistence, medication possession ratio (MPR), exacerbations, and costs (direct/indirect). The statistical analysis was performed using regression models, with a P<.05. RESULTS: A total of 3,203 patients were included in the study. By groups: a) FP/Form: 7.0% and b) Other-ICS/LABA: 93.0%. The mean age was 52.2 years, and 60.8% were women. A total of 44.9% of patients had persistent-moderate asthma. Patients under treatment with FP/Form were associated with greater persistence (67.6 vs. 61.2%, P=.043), a higher RPM (80.6 vs. 74.3%, P=.002), and less exacerbations (16.0 vs. 21.9%, P=.021), particularly severe-exacerbations (4.0 vs. 7.7%, P=.043). The mean/unit of the total cost (ANCOVA) was lower in patients under treatment with PF/Form (2,033 vs. € 2,486, P=.012), respectively. The total cost was associated with: Exacerbations (ß=0.618), asthma-severity (ß=0.214), age (ß=0.073), and lack-adherence (RPM: ß=-0.031), P<.01. CONCLUSIONS: Patients undergoing treatment with PF/Form were associated with greater adherence to treatment (persistence, RPM), a circumstance that leads to less severe exacerbations and total costs for the national health system. These differences could be due to the pharmacological properties of the drug or other factors not measured.

Impacto económico de la dermatitis atópica en adultos: estudio de base poblacional (estudio IDEA) / Economic Impact of Atopic Dermatitis in Adults: A Population-Based Study (IDEA Study)

OBJETIVO: Determinar el uso de los recursos y los costes de la dermatitis atópica (DA) en adultos según su gravedad y las comorbilidades asociadas en situación de práctica clínica habitual. PACIENTES Y MÉTODOS: Se efectuó un diseño observacional retrospectivo realizado a partir de la revisión de registros de pacientes ≥ 18 años que demandaron asistencia durante 2013-2014 en un área geográfica de Cataluña con una población de 215.634 personas. Se constituyeron 3 grupos de gravedad en función del tratamiento prescrito. Las variables evaluadas fueron el conjunto de comorbilidades, la medicación concomitante/específica; y los costes sanitarios directos/indirectos. El análisis estadístico se elaboró mediante modelos de regresión múltiple, p < 0,05. RESULTADOS: Se reclutaron 6.186 sujetos con diagnóstico de DA (edad-media: 47,1 años; mujeres, 61,6%). En función de la gravedad de la DA se consideraron 3 grupos; el 55,7% leve (n = 3.445), el 38,2% moderada (n = 2.361) y el 6,1% grave (n = 380). La DA grave se asoció a la probabilidad de presentar comorbilidades (Beta = 0,192); específicamente: asma (Beta = 0,138), depresión (Beta =0,099), eventos cardiovasculares (Beta = 0,087), obesidad (Beta = 0,085) y hábito tabáquico (Beta = 0,025), p < 0,001. El coste ascendió a 9,3 millones de euros (costes sanitarios: 75,5%; pérdidas de productividad: 24,5%), con un promedio/unitario de 1.504 euros/año. Los promedios/unitarios corregidos (ANCOVA) fueron mayores en la DA grave en comparación con la moderada y la leve (3.397 vs. 2.111 y 885 euros, respectivamente; p < 0,001). CONCLUSIONES: La DA grave se asocia a una elevada utilización de recursos sanitarios y costes para el Sistema Nacional de Salud proporcional a la gravedad de la dermatosis. La comorbilidad general y el asma fueron los factores con mayor impacto asociado al coste sanitario

OBJECTIVE: To determine resource usage and costs associated with atopic dermatitis in adults according to severity and comorbid conditions in daily clinical practice. PATIENTS AND METHODS: We performed an observational, retrospective study based on a review of registries of patients aged ≥ 18 years who sought health care in 2013 and 2014 in an area of Catalonia, Spain, with a population of 215,634 persons. We established 3 classes of severity depending on the treatment prescribed. The variables evaluated were total comorbid conditions, concomitant/specific medication, and direct/indirect health care costs. The statistical analysis was based on multiple regression models. Statistical significance was set at P < .05. RESULTS: We included 6,186 patients with a diagnosis of atopic dermatitis (mean age, 47.1 years; women, 61.6%). We established 3 groups based on severity, as follows: mild (n = 3,445 [55.7%]); moderate (n = 2,361 [38.2%]); and severe (n = 380 [6.1%]). Severe atopic dermatitis was associated with risk of presenting comorbid conditions (Beta = 0.192), namely, asthma (Beta = 0.138), depression (Beta = 0.099), cardiovascular events (Beta = 0.087), obesity (Beta = 0.085), and smoking (Beta = 0.025); P < .001. Costs reached Euros 9.3 million (health care costs, 75.5%; loss of productivity, 24.5%), with an average unit cost of Euros 1,504 per year. The corrected average unit cost (ANCOVA) was greater in severe atopic dermatitis compared with moderate and mild disease (Euros 3,397 vs. Euros 2,111 vs. Euros 885; P < .001), respectively. CONCLUSIONS: Severe atopic dermatitis generates considerable usage of health care resources and high costs for the National Health System. These are in proportion with the severity of the disease. General comorbid conditions and asthma were the factors with the greatest impact on health care costs

Uso de recursos y costes asociados a la no adherencia al tratamiento con corticoides inhalados en el asma / Use of resources and costs associated with non-adherence to inhaled corticosteroid treatment in asthma

Objetivo. Estimar la tasa de adherencia al tratamiento antiasmático con corticoide inhalado en condiciones de práctica clínica habitual, así como su relación con las exacerbaciones, el uso de recursos y los costes. Material y métodos. Estudio observacional retrospectivo realizado en el ámbito de Badalona Serveis Assistencials. Se incluyeron pacientes≥15 años con diagnóstico confirmado de asma que iniciaron tratamiento con corticoide inhalado entre enero 2010-diciembre 2011. El periodo de seguimiento fue de 24 meses. La adherencia al tratamiento se midió con la tasa de posesión de medicación, estableciéndose 2 grupos: pacientes adherentes (ADH; tasa de posesión de medicación≥80%) y no adherentes (no-ADH; tasa de posesión de medicación<80%). Se recogieron las variables demográficas y clínicas, las exacerbaciones, el uso de recursos sanitarios y no sanitarios (días de baja laboral) y los costes. Resultados. Se incluyeron 2.303 pacientes, con una edad media de 48,6 años, un 64,3% fueron mujeres y un 52,6% presentaban asma persistente moderada. Un 51,0% eran ADH al tratamiento. De los pacientes no-ADH, un 63,4% presentó exacerbaciones durante el periodo de estudio frente al 37,4% de los pacientes ADH (p<0,001), presentando, además, un mayor consumo de recursos sanitarios, especialmente visitas a Atención Primaria (22,5 vs. 17,4%), especializada (3,3 vs. 2,5%) y urgencias (1,4% vs. 0,2%) (p<0,001 en todos los casos). No se encontraron diferencias estadísticamente significativas en los días de baja laboral. El coste total anual fue de 1.431€/paciente no-ADH frente a 722€/paciente ADH (p<0,001). Conclusión. La falta de adherencia se relacionó con un aumento de la tasa de exacerbaciones, así como del consumo de recursos sanitarios y costes (AU)

Objective. To estimate adherence to asthma treatment with inhaled corticosteroid in clinical daily practice, and its relationship with exacerbations, as well as its use of resources and costs. Material and methods. An observational, retrospective study using the electronic medical records of the Badalona Health Service provider. The study included patients≥15 years old with a confirmed diagnosed of asthma, and who initiated treatment with an inhaled corticosteroid between January 2010 and December 2011. The follow-up period was 24 months. Adherence to treatment was measured using the medication possession ratio. Two groups were established: adherent (ADH; medication possession ratio≥80%) and non-adherent (non-ADH; medication possession ratio<80%) patients. The main demographic and clinical variables, including exacerbations, were collected, along with the healthcare and non-healthcare (days of absence from work) resource use, and costs. Results. The study included a total of 2,303 patients, with a mean age of 48.6 years, and 64.3% females. Just over half (52.6%) of the patients had moderate persistent asthma, and 51.0% of patients adhered to treatment. In the non-ADH patients, 63.4% suffered at least one exacerbation in the follow-up period, compared with 37.4% of the adherent patients (P<.001). The non-ADH patients also consumed a higher percentage of healthcare resources in Primary Care (22.5 vs. 17.4%), secondary care (3.3 vs. 2.5%), and emergency visits (1.4 vs. 0.2%) during the follow-up period (P<.001 in all cases). No statistical significance differences were observed in the days of absence from work. Mean annual cost of non-ADH patients was 1,431€/patient, compared with 722€/patient (P<.001) of ADH patients. Conclusion. Lack of adherence was associated with an increase in exacerbation rates, as well as healthcare resource consumption and costs (AU)

Clinical and economic consequences of treating patients with peripheral neuropathic pain with brand name or generic drugs in routine clinical practice: The effects of age and sex. / Efecto de la edad y el género sobre las consecuencias clínicas y económicas del tratamiento con especialidad farmacéutica de marca o genérica en pacientes con dolor neuropático periférico en práctica clínica habitual.

OBJECTIVE: We aimed to analyse the effects of age and sex on pain and cost for patients with chronic peripheral neuropathic pain (PNP) who have started treatment with brand name gabapentin versus generic gabapentin (EFG). METHODS: We conducted a retrospective multicentre study using electronic medical records (EMR) for patients of both sexes, older than 18, who began treatment with brand name or generic gabapentin. Adherence (medication possession ratio [MPR]), persistence, use of healthcare resources, cost, and pain reduction were measured for one year. RESULTS: We analysed 1369 EMRs [61.1% women; mean age 64.6 (15.9), 52.4%≥65 years]; 400 used brand name drugs while 969 used generic gabapentin. Persistence and adherence were higher in patients using brand name gabapentin (7.3 vs 6.3 months, P<.001; 86.5% vs 81.3% MPR, P<.001). Lower healthcare costs were observed in patients using brand-name gabapentin in both age groups (<65 and ≥65). Mean difference in cost per patient amounted to €221 (95%CI: 59-382) and €217 (95%CI: 51-382) in the <65 and ≥65 age groups, respectively (P<.01). Mean difference in cost among men amounted to €197 (63-328), while mean difference in cost among women amounted to €239 (96-397) (P=.005 and P=.004, respectively). Compared with EFG, brand treatment showed greater pain relief: 13.5% (10.9-16.2) and 10.8% (8.2-13.5) in <65 and ≥65year patients, respectively (P<.001), and 10.7% (8.2-13.2) and 13.8% (11.0-16.5) in women and men respectively (P<.001). CONCLUSIONS: Regardless of sex and age, patients who started PNP treatment with brand name medication showed greater persistence and adherence to treatment than those taking generic drugs. Brand name treatment also involved lower healthcare costs, and greater pain relief.

Economic Impact of Atopic Dermatitis in Adults: A Population-Based Study (IDEA Study). / Impacto económico de la dermatitis atópica en adultos: estudio de base poblacional (estudio IDEA).

OBJECTIVE: To determine resource usage and costs associated with atopic dermatitis in adults according to severity and comorbid conditions in daily clinical practice. PATIENTS AND METHODS: We performed an observational, retrospective study based on a review of registries of patients aged ≥18 years who sought health care in 2013 and 2014 in an area of Catalonia, Spain, with a population of 215,634 persons. We established 3 classes of severity depending on the treatment prescribed. The variables evaluated were total comorbid conditions, concomitant/specific medication, and direct/indirect health care costs. The statistical analysis was based on multiple regression models. Statistical significance was set at P<.05. RESULTS: We included 6,186 patients with a diagnosis of atopic dermatitis (mean age, 47.1 years; women, 61.6%). We established 3 groups based on severity, as follows: mild (n=3,445 [55.7%]); moderate (n=2,361 [38.2%]); and severe (n=380 [6.1%]). Severe atopic dermatitis was associated with risk of presenting comorbid conditions (ß=0.192), namely, asthma (ß=0.138), depression (ß=0.099), cardiovascular events (ß=0.087), obesity (ß=0.085), and smoking (ß=0.025); P<.001. Costs reached €9.3 million (health care costs, 75.5%; loss of productivity, 24.5%), with an average unit cost of €1,504 per year. The corrected average unit cost (ANCOVA) was greater in severe atopic dermatitis compared with moderate and mild disease (€3,397 vs. €2,111 vs. €885; P<.001), respectively. CONCLUSIONS: Severe atopic dermatitis generates considerable usage of health care resources and high costs for the National Health System. These are in proportion with the severity of the disease. General comorbid conditions and asthma were the factors with the greatest impact on health care costs.

[Use of resources and costs associated with non-adherence to inhaled corticosteroid treatment in asthma]. / Uso de recursos y costes asociados a la no adherencia al tratamiento con corticoides inhalados en el asma.

OBJECTIVE: To estimate adherence to asthma treatment with inhaled corticosteroid in clinical daily practice, and its relationship with exacerbations, as well as its use of resources and costs. MATERIAL AND METHODS: An observational, retrospective study using the electronic medical records of the Badalona Health Service provider. The study included patients≥15 years old with a confirmed diagnosed of asthma, and who initiated treatment with an inhaled corticosteroid between January 2010 and December 2011. The follow-up period was 24 months. Adherence to treatment was measured using the medication possession ratio. Two groups were established: adherent (ADH; medication possession ratio≥80%) and non-adherent (non-ADH; medication possession ratio<80%) patients. The main demographic and clinical variables, including exacerbations, were collected, along with the healthcare and non-healthcare (days of absence from work) resource use, and costs. RESULTS: The study included a total of 2,303 patients, with a mean age of 48.6 years, and 64.3% females. Just over half (52.6%) of the patients had moderate persistent asthma, and 51.0% of patients adhered to treatment. In the non-ADH patients, 63.4% suffered at least one exacerbation in the follow-up period, compared with 37.4% of the adherent patients (P<.001). The non-ADH patients also consumed a higher percentage of healthcare resources in Primary Care (22.5 vs. 17.4%), secondary care (3.3 vs. 2.5%), and emergency visits (1.4 vs. 0.2%) during the follow-up period (P<.001 in all cases). No statistical significance differences were observed in the days of absence from work. Mean annual cost of non-ADH patients was 1,431€/patient, compared with 722€/patient (P<.001) of ADH patients. CONCLUSION: Lack of adherence was associated with an increase in exacerbation rates, as well as healthcare resource consumption and costs.

Prevalence of severe atopic dermatitis in adults in 3 areas of Spain

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Estudio observacional retrospectivo multicéntrico de pacientes con vejiga hiperactiva en tratamiento con mirabegrón y oxibutinina en condiciones de práctica clínica habitual / A retrospective, observational and multicentre study on patients with hyperactive bladder on treatment with mirabegron and oxybutinine under usual clinical practice conditions

Objetivo. Evaluar la persistencia terapéutica, el coste sanitario y las reacciones adversas en pacientes tratados con oxibutinina y mirabegrón para el tratamiento de la vejiga hiperactiva en condiciones de práctica médica habitual. Pacientes y métodos. Se diseñó un estudio observacional, multicéntrico, retrospectivo, realizado a partir de registros médicos de pacientes pertenecientes a 3 áreas geográficas distintas (Barcelona, Girona, Asturias). Se analizaron los 2 grupos de estudio (oxibutinina y mirabegrón). El seguimiento se realizó durante un año. La persistencia se definió como el tiempo (meses) sin abandono del tratamiento inicial o sin cambio a otra medicación al menos 60 días después de la prescripción inicial. Principales medidas: comorbilidad, uso de recursos sanitarios y reacciones adversas. Programa SPSSWIN; p<0,05. Resultados. Se analizaron 1.277 sujetos. La media de edad fue de 69,3 años y el 53,2% fueron mujeres. Por grupos: 42,9% oxibutinina y 57,1% mirabegrón. Las características demográficas y la morbilidad fueron parecidas. Los pacientes en tratamiento con oxibutinina en comparación con mirabegrón presentaron una similar persistencia al tratamiento (35,0 vs. 32,2%, p=0,294), aunque menores costes (1.151,2 vs. 1.809,6€, p<0,001). Las diferencias mayores se observaron en el precio de la medicación (279,2 vs. 692,3€, p<0,001; diferencia: −4131,€) y en las reacciones adversas (9,7 vs. 4,9%, p<0,001). Conclusiones. Los pacientes en tratamiento con oxibutinina frente a mirabegrón para la vejiga hiperactiva se asociaron a una parecida persistencia al tratamiento, menores costes sanitarios y mayores tasas de reacciones adversas de oxibutinina frente a mirabegrón

Objective. To evaluate therapeutic persistence, healthcare resources, medical costs and adverse events of oxybutynin and mirabegron treatments in patients with overactive bladder in routine medical practice. Patients and methods. An observational, retrospective, multicentre study was carried out using the records of patients attended to in 3 different geographic locations (Barcelona, Girona, Asturias). An analysis was made on the 2 study groups (oxybutynin and mirabegron). Follow-up time was one year. Persistence was defined as the time (months), without discontinuation of the initial treatment, or without change of treatment at least 60 days after the initial prescription. Primary endpoints: comorbidity, healthcare resources used, and adverse events. The data was analysed using the SPSSWIN Program, with a significance of P<.05. Results. Of the total of1,277 patients included in the study, 42.9% were on oxybutynin and 57.1% mirabegron. The mean age was 69.3 years and 53.2% were female. Demographic characteristics and morbidity were similar between the drugs and had a similar persistence (35.0% oxybutynin vs. 32.2% mirabegron, P=.294), although their costs were lower (1,151.2 vs. €1,809.6, P<.001). The biggest differences were observed in the price of medication (279.2 vs. €692.3, P<.001; a variation of: −€413.1); and adverse events (9.7 vs. 4.9%, P<.001). Conclusions. Patients treated with oxybutynin vs. mirabegron for overactive bladder had similar persistence with the treatment, lower healthcare costs, but with higher oxybutynin vs. mirabegron adverse reaction rates (AU)

[A retrospective, observational and multicentre study on patients with hyperactive bladder on treatment with mirabegron and oxybutinine under usual clinical practice conditions]. / Estudio observacional retrospectivo multicéntrico de pacientes con vejiga hiperactiva en tratamiento con mirabegrón y oxibutinina en condiciones de práctica clínica habitual.

OBJECTIVE: To evaluate therapeutic persistence, healthcare resources, medical costs and adverse events of oxybutynin and mirabegron treatments in patients with overactive bladder in routine medical practice. PATIENTS AND METHODS: An observational, retrospective, multicentre study was carried out using the records of patients attended to in 3 different geographic locations (Barcelona, Girona, Asturias). An analysis was made on the 2 study groups (oxybutynin and mirabegron). Follow-up time was one year. Persistence was defined as the time (months), without discontinuation of the initial treatment, or without change of treatment at least 60 days after the initial prescription. Primary endpoints: comorbidity, healthcare resources used, and adverse events. The data was analysed using the SPSSWIN Program, with a significance of P<.05. RESULTS: Of the total of1,277 patients included in the study, 42.9% were on oxybutynin and 57.1% mirabegron. The mean age was 69.3 years and 53.2% were female. Demographic characteristics and morbidity were similar between the drugs and had a similar persistence (35.0% oxybutynin vs. 32.2% mirabegron, P=.294), although their costs were lower (1,151.2 vs. €1,809.6, P<.001). The biggest differences were observed in the price of medication (279.2 vs. €692.3, P<.001; a variation of: -€413.1); and adverse events (9.7 vs. 4.9%, P<.001). CONCLUSIONS: Patients treated with oxybutynin vs. mirabegron for overactive bladder had similar persistence with the treatment, lower healthcare costs, but with higher oxybutynin vs. mirabegron adverse reaction rates.

Persistencia y medicación concomitante en pacientes con vejiga hiperactiva tratados con antimuscarínicos en atención primaria: estudio de base observacional / Persistence and concomitant medication in patients with overactive bladder treated with antimuscarinic agents in primary care. An observational baseline study

Objetivo: Evaluar la persistencia terapéutica y su relación con la medicación concomitante en pacientes tratados con fesoterodina frente a tolterodina y solifenacina para el tratamiento de la vejiga hiperactiva en condiciones de práctica médica habitual. Material y métodos: Se efectuó un diseño observacional, multicéntrico, retrospectivo, realizado a partir de registros médicos de pacientes seguidos en atención primaria. Se analizaron los 3 grupos de estudio. La persistencia se definió como el tiempo (meses), sin abandono del tratamiento inicial o sin cambio a otra medicación al menos 30 días después de la prescripción inicial. La medicación concomitante fue: antidepresivos, ansiolíticos/hipnóticos, antibióticos, antisépticos, laxantes y productos-dermatológicos. Se utilizó el programa SPSSWIN versión 17 (significación estadística: p < 0,05). Resultados: Se seleccionaron para el estudio 3.094 pacientes. La media de edad fue de 54,0 años y el 62,2% fueron mujeres. Los pacientes tratados con fesoterodina mostraron mayor persistencia al tratamiento (12 meses) en comparación con solifenacina y tolterodina (40,2% frente al 34,7% y 33,6%; p = 0,008), respectivamente. Además, también mostraron un menor uso de medicación concomitante (1,1 frente a 1,2 y 1,2 fármacos; porcentajes: 61,6% frente a 67,1% y 70,1%; p < 0,03). Conclusiones: Los pacientes en tratamiento con fesoterodina frente a solifenacina y tolterodina para la vejiga hiperactiva se asociaron a una mayor persistencia al tratamiento, con una reducción de la medicación concomitante

Objective: To assess therapeutic persistence and its relationship with concomitant medication in patients treated with fesoterodine versus tolterodine and solifenacin for overactive bladder (OAB) in standard clinical practice conditions. Material and methods: An observational, multicentre retrospective study was performed based on medical registries of patients followed-up in primary care (PC). Three study groups were analysed. Persistence was defined as the time (in months) without withdrawing from the initial therapy or without changing to another medication for at least 30 days after the initial prescription. The concomitant medications were antidepressants, anxiolytic/hypnotic agents, antibiotics, antiseptic agents, laxatives and skin products. We employed the SPSSWIN program version 17 (statistical significance, P < .05). Results: We selected 3094 patients for the study. The median age was 54.0 years and 62.2% were women. The patients treated with fesoterodine shown greater treatment persistence (12 months) when compared with those who took solifenacin and tolterodine (40.2% vs. 34.7% and 33.6%, respectively; P = .008). They also showed a lower use of concomitant medication (1.1 vs. 1.2 and 1.2 drugs, respectively; percentages: 61.6% vs. 67.1% and 70.1%, respectively; P < .03). Conclusions: The patients undergoing OAB treatment with fesoterodine, when compared with those taking solifenacin and tolterodine, were associated with greater treatment persistence and a reduced use of concomitant medication

Persistence and concomitant medication in patients with overactive bladder treated with antimuscarinic agents in primary care. An observational baseline study.

OBJECTIVE: To assess therapeutic persistence and its relationship with concomitant medication in patients treated with fesoterodine versus tolterodine and solifenacin for overactive bladder (OAB) in standard clinical practice conditions. MATERIAL AND METHODS: An observational, multicentre retrospective study was performed based on medical registries of patients followed-up in primary care (PC). Three study groups were analysed. Persistence was defined as the time (in months) without withdrawing from the initial therapy or without changing to another medication for at least 30 days after the initial prescription. The concomitant medications were antidepressants, anxiolytic/hypnotic agents, antibiotics, antiseptic agents, laxatives and skin products. We employed the SPSSWIN program version 17 (statistical significance, P<.05). RESULTS: We selected 3094 patients for the study. The median age was 54.0 years and 62.2% were women. The patients treated with fesoterodine shown greater treatment persistence (12 months) when compared with those who took solifenacin and tolterodine (40.2% vs. 34.7% and 33.6%, respectively; P=.008). They also showed a lower use of concomitant medication (1.1 vs. 1.2 and 1.2 drugs, respectively; percentages: 61.6% vs. 67.1% and 70.1%, respectively; P<.03). CONCLUSIONS: The patients undergoing OAB treatment with fesoterodine, when compared with those taking solifenacin and tolterodine, were associated with greater treatment persistence and a reduced use of concomitant medication.

Uso de recursos sanitarios y costes asociados en pacientes ancianos vulnerables no institucionalizados con vejiga hiperactiva tratados con antimuscarínicos en la práctica médica habitual / Use of health care resources and associated costs in non-institutionalized vulnerable elders with overactive bladder treated with antimuscarinic agents in the usual medical practice

Objetivo: Evaluar el uso de recursos y costes sanitarios en pacientes ancianos vulnerables no institucionalizados con vejiga hiperactiva (VH) tratados con fesoterodina, solifenacina o tolterodina en la práctica médica habitual. Material y métodos: Estudio multicéntrico, retrospectivo, realizado a partir de los registros de pacientes atendidos durante 2008-2010 en 3 localidades geográficas y que iniciaron tratamiento con antimuscarínicos (fesoterodina, solifenacina y tolterodina) para la VH. El atributo de vulnerabilidad se basó en reunir, al menos, 3 de los criterios del Vulnerable-Elders Survey-13; edad > 75 años, salud pobre/normal para la edad y alguna dificultad en al menos una actividad física diaria. Principales medidas: comorbilidad, persistencia y uso de recursos y costes. El seguimiento de los pacientes se realizó durante 52 semanas. Se utilizó un modelo lineal general con covariables y remuestreo (1.000) aleatorio para construir el IC 95% de las diferencias de costes entre fármacos. Resultados: Se analizaron registros de 552 pacientes (50,8% mujeres, edad media: 80,2 años), tratados con fesoterodina (n = 58), solifenacina (n = 252) o tolterodina (n = 212). El uso de absorbentes fue del 20,7, 29,4 y 33,0% (p = 0,186), respectivamente. La persistencia al tratamiento fue ligeramente mayor con fesoterodina. Los costes sanitarios paciente/año fueron inferiores con fesoterodina, 1.775 euros (1.550-2.014) vs. solifenacina 2.062 euros (1.911-2.223) y tolterodina 2.149 euros (1.978-2.307), p = 0,042, como consecuencia de una menor utilización de visitas y medicación concomitante. Conclusiones: A pesar de las posibles limitaciones del estudio, los pacientes ancianos vulnerables no institucionalizados con VH tratados con fesoterodina, en comparación con solifenacina o tolterodina, se asociaron a una menor utilización de recursos y costes sanitarios

Objective: To evaluate the use of resources and health costs in vulnerable elderly institutionalized patients with overactive bladder (OAB) treated with fesoterodine, tolterodine or solifenacin in routine medical practice. Material and methods: A multicenter retrospective study, from the records of patients treated during 2008-2010 in three geographical locations and starting treatment with antimuscarinic (fesoterodine, solifenacin and tolterodine) for OAB. The attribute of vulnerability was based on collecting at least 3 of the Vulnerable Elders Survey criteria-13, age > 75 years, poor/average age for health and difficulty in at least one daily physical activity. Main measures: morbidity, persistence and resource use and costs. Monitoring of patients was conducted over 52 weeks. A general linear model with covariates and bootstraping (1000) at random was used to construct the 95% CI of the cost differences between drugs. Results: Records of 552 patients (50.8% women, mean age: 80.2 years) were analyzed. Treated with fesoterodine (N = 58), solifenacin (N = 252) or tolterodine (N = 212). The use of absorbent was 20.7%, 29.4% and 33.0% (p = 0.186), respectively. Persistence to treatment was slightly greater with fesoterodine. The patient healthcare costs/year were lower with fesoterodine, euros 1775 (1550-2014) vs. solifenacin euros 2062 (1911-2223) and tolterodine euros 2149 (1978-2307), p = 0.042, as a result of lower utilization visits and concomitant medication. Conclusions: Despite the potential limitations of the study, the vulnerable elderly non institutionalized patients with OAB treated with fesoterodine, compared to solifenacin or tolterodine were associated with lower resource utilization and healthcare costs

Características clínicas y económicas asociadas a la diabetes tipo 2 / Clinical and economic characteristics associated with type 2 diabetes

Objetivos. La diabetes mellitus tipo 2 (DM2) suele acompañarse de diversas comorbilidades que pueden incrementar el coste de su tratamiento. No conocemos estudios que hayan determinado los costes asociados al tratamiento de los enfermos con DM2 que, además padecen sobrepeso (SP), obesidad (OBE) o hipertensión arterial (HTA). Hemos examinado el gasto sanitario y la incidencia de enfermedad cardiovascular (ECV) en estos enfermos. Pacientes y métodos. Diseño observacional-multicéntrico de carácter retrospectivo. Se incluyeron pacientes entre 40-99 años que demandaron atención durante 2010 en Badalona (Barcelona, España). Se establecieron 2 grupos de estudio: presencia-DM2 y ausencia-DM2 (referencia/control), y 6 subgrupos: DM2-solo, DM2-HTA, DM2-SP, DM2-OBE; DM2-HTA-SP y DM2-HTA-OBE. Las principales medidas fueron: comorbilidad, síndrome metabólico (SM), complicaciones (hipoglucemias, ECV) y costes (sanitarios; no-sanitarios). El seguimiento se realizó durante 2 años. Resultados. Se reclutaron 26.845 pacientes. La prevalencia de DM2 fue del 14,0%. Los sujetos con DM2 mostraron mayor edad (67,8 vs. 59,7 años) y porcentaje de varones (51,3 vs. 43,0%), p<0,001. La DM2 se asoció principalmente a OBE (OR:2,8; IC 95%: 2,4-3,1), HTA (OR:2,4; IC 95%: 2,2-2,6) y SP (OR:1,9; IC 95%: 1,7-2,2). La distribución por subgrupos osciló entre el 6,7% para los enfermos que solo presentaban DM2, y el 26,1% para los diagnosticados de DM2-HTA-SP y el 34,1% para los que tenían DM2-HTA-OBE. El SM se identificó en el 75,4% y un 37,5% refirió algún episodio de hipoglucemia. El coste-total/paciente con DM2 al cabo de 2 años fue de 4.458€. Por subgrupos fue de DM2: 3.431€; DM2-HTA: 4.075€; DM2-SP: 4.057€; DM2-OBE: 4.915€; DM2-HTA-SP: 4.203€ y DM2-HTA-OBE: 5.02€ (p<0,001). La tasa de ECV en los enfermos con DM2 fue del 4,7%, y del 1,7% en los que no padecían esta condición (p<0,001). Conclusiones. La OBE es una comorbilidad asociada a la DM2 que origina un mayor gasto sanitario que la HTA. La presencia de estas comorbilidades ocasiona mayores tasas de ECV (AU)

Objectives. Type 2 diabetes mellitus (DM2) is usually accompanied by various comorbidities that can increase the cost of treatment. We are not aware of studies that have determined the costs associated with treating DM2 patients with co-morbidities such as overweight (OW), obesity (OBE) or arterial hypertension (AHT). The aim of the study was to examine the health-related costs and the incidence of cardiovascular disease (CVD) in these patients. Patients and methods. Multicenter, observational retrospective design. We included patients 40-99 years of age who requested medical attention in 2010 in Badalona (Barcelona, Spain). There were two study groups: those with DM2 and without DM2 (reference group/control), and six subgroups: DM2-only, DM2-AHT, DM2-OW, DM2-OBE; DM2-AHT-OW and DM2-AHT-OBE. The main outcome measures were: co-morbidity, metabolic syndrome (MS), complications (hypoglycemia, CVD) and costs (health and non-health). Follow-up was carried out for two years. Results. A total of 26,845 patients were recruited. The prevalence of DM2 was 14.0%. Subjects with DM2 were older (67.8 vs. 59.7 years) and more were men (51.3 vs. 43.0%), P<.001. DM2 status was associated primarily with OBE (OR=2.8, CI=2.4-3.1), AHT (OR=2.4, CI=2.2-2.6) and OW (OR=1.9, CI=1.7-2.2). The distribution by subgroups was: 6.7% of patients had only DM2, 26.1% had DM2, AHT and OW, and 34.1% had DM2, AHT, and OBE. Some 75.4% had MS and 37.5% reported an episode of hypoglycemia. The total cost/patient with DM2 was €4,458. By subgroups the costs were as follows: DM2: €3,431; DM2-AHT: €4,075; DM2-OW: €4,057; DM2-OBE: €4,915; DM2-AHT-OW: €4,203 and DM2-AHT-OBE: €5,021, P<.001. The CVD rate among patients with DM2 was 4.7 vs. 1.7% in those without DM2 P<.001. Conclusions. Obesity is a comorbidity associated with DM2 that leads to greater healthcare costs than AHT. The presence of these comorbidities causes increased rates of CVD (AU)

Use of health care resources and associated costs in non-institutionalized vulnerable elders with overactive bladder treated with antimuscarinic agents in the usual medical practice.

OBJECTIVE: To evaluate the use of resources and health costs in vulnerable elderly institutionalized patients with overactive bladder (OAB) treated with fesoterodine, tolterodine or solifenacin in routine medical practice. MATERIAL AND METHODS: A multicenter retrospective study, from the records of patients treated during 2008-2010 in three geographical locations and starting treatment with antimuscarinic (fesoterodine, solifenacin and tolterodine) for OAB. The attribute of vulnerability was based on collecting at least 3 of the Vulnerable Elders Survey criteria-13, age>75 years, poor/average age for health and difficulty in at least one daily physical activity. MAIN MEASURES: morbidity, persistence and resource use and costs. Monitoring of patients was conducted over 52 weeks. A general linear model with covariates and bootstraping (1000) at random was used to construct the 95% CI of the cost differences between drugs. RESULTS: Records of 552 patients (50.8% women, mean age: 80.2 years) were analyzed. Treated with fesoterodine (N=58), solifenacin (N=252) or tolterodine (N=212). The use of absorbent was 20.7%, 29.4% and 33.0% (P=.186), respectively. Persistence to treatment was slightly greater with fesoterodine. The patient healthcare costs/year were lower with fesoterodine, €1,775 (1550-2014) vs. solifenacin €2,062 (1911-2223) and tolterodine €2,149 (1,978-2,307), P=.042, as a result of lower utilization visits and concomitant medication. CONCLUSIONS: Despite the potential limitations of the study, the vulnerable elderly non institutionalized patients with OAB treated with fesoterodine, compared to solifenacin or tolterodine were associated with lower resource utilization and healthcare costs.

Influence of combinations of drugs that act on the CYP2D6 metabolic pathway in the treatment of major depressive disorder: a population-based study.

OBJECTIVE: To describe the frequency of drug combinations (substrate-substrate or substrate-inhibitor) with the potential to interfere with the CYP2D6 metabolic pathway in patients receiving antidepressant medication for major depressive disorder. METHODS: We carried out an observational study using outpatient medical records. We included adult subjects who initiated antidepressant medication during 2008-2010. Patients were assigned to three study groups: no combination, substrate-substrate, and substrate-inhibitor. Follow-up period was 12 months. MAIN MEASURES: demographics, comorbidity and medication persistence. Statistical analysis included a logistic regression model, P<0.05. RESULTS: Five thousand six hundred and thirty patients were recruited (61.9 years, 76.9% female), 24.4% (CI: 23.8 - 26.0%) received some kind of drug combination (substrate-substrate: 15.4%, substrate-inhibitor: 9.0%). Variables significantly associated with drugs combinations that may act on the CYP2D6 metabolic pathway were: dementia (OR=4.2), neuropathy (OR=4.2) and stroke (OR=1.9), P<0.001. Medication persistence at 12 months was longer in patients with no combination (55.3%) than in patients receiving substrate-substrate (50.5%) or substrate-inhibitor (45.0%) combinations, P<0.001. CONCLUSIONS: Twenty-five percent of major depressive disorder patients received a combination of drugs with the potential to interfere with CYP2D6 metabolic pathway. These combinations increased with comorbidity and resulted in shorter medication persistence of antidepressant treatment.