It improves with age Adherence Like Why is Patient VP Analytical - - PDF document
October 15, 2009 It improves with age Adherence Like Why is Patient VP Analytical Paul Wilson Services Wine? Why is Adherence Important? Medication non-adherence estimated to lead to over $177 Billion in unnecessary health care costs in the
(Ernst and Grizzle, J Amer Pharmaceutical Assoc 41(2), 2001)
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reduces plaque formation1
cancer by 45%3
functioning5
1 International Journal Molecular Medicine 2005 2 Columbia University study, Stroke 2006 3 Amer Journal GastroEntology, 2005 4 Columbia University NeuroEpidemiology 2006 5 University of Buffalo study, Amer Thoracic Society 2002 6 St Thomas Hospital, London study 2004
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Source: AstraZeneca Physician Survey October 2008
Reasons patients don’t take their prescriptions as instructed Percent Affordability of medication 20% Patient feels they do not need medication 20% Side effects of medication 17% Forgetfulness 16% Lack of concern for their condition 5% Lack of information on disease 5% Lack of information of Rx prescribed 5% Lack of family/social support 5% Low satisfaction with Rx prescribed 3% Poor relationship w/ pharmacist or physician 2% Patient Received Prior recommendation against the drug 2%
MPR: # of days’ supply during the analysis period / number of days during the analysis period. Cohort includes all patients filling during August 2008, analysis period is 365 days. Source: Catalina Health Resource
Differences in adherence become apparent when looking at MPRs: Pharmacies outperform Food Stores in all four therapeutic categories
Persistence in Type-2 Diabetes is better in Pharmacies than in Food Stores
Data are for the type 2 diabetes market, but similar results were seen in other chronic therapeutic areas Source: Catalina Health Resource
Observation: Patients with 90-days’ supply are more persistent than those with 30-days’ supply
Percent of patients persistent as of fill x with a 30-day grace period Source: Catalina Health Resource
Percent of patients persistent as of fill x with a 30-day grace period Source: Catalina Health Resource
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Source: AstraZeneca Physician Survey October 2008
Reasons patients don’t take their prescriptions as instructed Percent Affordability of medication 20% Patient feels they do not need medication 20% Side effects of medication 17% Forgetfulness 16% Lack of concern for their condition 5% Lack of information on disease 5% Lack of information of Rx prescribed 5% Lack of family/social support 5% Low satisfaction with Rx prescribed 3% Poor relationship w/ pharmacist or physician 2% Patient Received Prior recommendation against the drug 2%
Patient cohort: all patients filling Brand x and Generic y during August 2008. Analysis period is one year. Source: Catalina Health Resource
Cash Medicaid Medicare Part D Third Party Brand Generic Brand Generic Brand Generic Brand Generic Patient Count 23,967 40,370 26,972 29,227 204,490 289,542 962,208 1,210,974 Avg Rx per Patient 4.3 5.2 7.2 7.7 7.4 7.8 7.3 7.2 Avg Pills per Patient 156.7 207.1 236.0 248.6 261.4 283.1 242.7 253.1 Compliance Rate 78.2% 82.6% 81.8% 81.2% 85.5% 86.5% 83.9% 84.3% Medical Possession Ratio 42.8% 54.7% 63.7% 66.1% 70.8% 74.9% 66.8% 68.0% Days Late 23.8 17.2 13.3 13.7 11.2 10.2 11.6 11.7
Patient cohort: all patients filling Brand x and Generic y during August 2008. Analysis period is one year. Grace period is 30 days. Source: Catalina Health Resource
Note: Among covered workers. Years shown (9) are 2000 through 2008.Source: Kaiser Family Foundation (Employer Health Benefits 2008).
Average Rx copayment by cost sharing tier (2000-2008) Drug cost sharing classification
Source: Goldman et al., JAMA (2004); 291: 2344-2350.
Change in days supplied after doubling copay (2004) Drug category
Source: G&S Research Note: Values <5% are not displayed in chart. How much would you say you like or dislike receiving these coupons for products related to your health when you pick up your prescriptions? (Of the 16% of patients who received coupons, n=805)
Opinion of Health-Related Coupons Received with Prescriptions
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All metrics are for the Cholesterol Market, but similar results were seen for the other chronic therapeutic categories. Source: Catalina Health Resource
All metrics are for the Type 2 Diabetes market, but similar results were seen for the other chronic therapeutic categories. Source: Catalina Health Resource
Surprise! Women are less adherent than men in both Food Stores and in Pharmacies, both genders visit both store types equally
Compliance Rate MPR Days Late Total Days of Therapy Food Stores Men 89.9% 72.7% 8.3 238.6 Women 88.2% 70.2% 9.7 235.7 Pharmacies Men 89.7% 78.2% 8.1 280.1 Women 88.0% 75.8% 9.5 276.8
Gender Men Women Food Stores 19.3% 19.6% Pharmacies 80.7% 80.4%
Patient Selection Period 120 days (August 07 – October 07)
Transaction period 52 weeks (November 07 – October 08)
Hypertension Adherence Behavior
All Hypertension Brand X Patients
Base=104,751 (100%) % ADH=64.1
Patients with Congestive Heart Failure
N = 6,833 (7%) % ADH = 80.0
Patients Aged LE49
N = 12,463 (12%) % ADH = 56.6
Patients Aged 50-64
N = 33,330 (32%) % ADH = 59.6
Patients Aged GE65
N = 52,125 (49%) % ADH = 66.8
Patients with Low Income (le42.5K)
N = 1,570 (2%) % ADH = 77.7
Patients with Medium Income (42.5-69.6K)
N = 3,584 (3%) % ADH = 79.7
Patients with High Income (GE 69.6K)
N = 1,570 (2%) % ADH = 83.3
BRANCH # 1 BRANCH # 2 BRANCH # 3
Patients without Congestive Heart Failure
N = 97,918 (93%) % ADH = 63.0
% ADH = patients with MPR >=70% Source: Catalina Health Resource
Patients with Diabetes
N = 15,444 (15%) % ADH = 63.1
Patients without CHF and with Age 50-64
N = 33,361 (32%) % ADH = 59.6
Patients without BetaBlockers
N = 9,111 (9%) % ADH = 53.3
Patients without Diabetes
N = 17,917 (17%) % ADH = 56.6
Patients taking Beta Blockers
N = 8806 (8%) % ADH = 60.1
Patients with Poor HT Control
N = 5,336 (5%) % ADH = 66.3
Patients with Medium HT Control
N = 4,350 (4%) % ADH = 63.3
Patients with Good HT Control
N = 5,758 (6%) % ADH = 59.9
BRANCH # 2
% ADH = patients with MPR >=70% Source: Catalina Health Resource
New Patients typically respond better to adherence programs, however, they generally only represent 30-40% of the patient population
Source: Catalina Health Resource
0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 54.0% 56.0% 58.0% 60.0% 62.0% 64.0% 66.0% 68.0%
Adherence - Continuing Patient Decision Tree
Lift on Pills after 1st Message
Lift Linear (Lift)
Segments with below average adherence have a program lift that is higher than average Segments with below average adherence have a program lift that is higher than average
Source: Catalina Health Resource
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Brand X suffered a series of bad news items in the press, first in January 2008 then again in March 2008, cutting monthly new patient starts by more than half
All new patients filling an Rx each month, with a 180-day lookback period. Source: Catalina Health Resource
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would help them remember to refill their prescriptions.
more information about their condition.
Where 1=‘Not at all likely’ and where 7=‘Very likely”
“Remember to refill your prescription because of what you read” “Look for more information about your condition because of what you read” "Look for information about help paying for your prescription because of what you read" "Look for information about a new product because of what you read” Ask your doctor about a different product because of what you read"
providers
adherence and attaining realistic health goals
information to higher risk patients regarding the importance of adherence
What do you, personally see as the biggest problem with health care in the USA today?
Source: USA Today/Gallup Poll of 1030 adults; 9/23/2009.
Professor, Department of Clinical Epidemiology and Biostatistics, McMaster University
as quoted in Adherence to Long-Term Therapies: Evidence for Action, World Health Organization, 2003
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