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The Duality of Economic Issues With Medication Non-adherence in Patients With Inflammatory Arthritis

Abstract

Purpose of Review

In this review, we synthesize current data on non-adherence across inflammatory arthritides and explore (1) the effects of economic factors on non-adherence and (2) the impacts of non-adherence on economic outcomes.

Recent Findings

Recent evidence demonstrates medication non-adherence rates as high as 74% in ankylosing spondylitis (AS), 90% in gout, 50% in psoriatic arthritis (PsA), 75% in systemic lupus erythematosus (SLE), and 82% in rheumatoid arthritis (RA).

Summary

The effects of socioeconomic factors have been studied most in RA and SLE but with inconsistent findings. Nonetheless, the evidence points to having prescription coverage and costs of treatment as important factors in RA and education as an important factor in SLE. Limited data in AS and gout, and no studies of the effects of socioeconomic factors in PsA, show knowledge gaps for future research. Finally, there is a dearth of data with respect to the impacts of non-adherence on economic outcomes.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.

    • De Vera MA, Marcotte G, Rai S, et al. Medication adherence in gout: a systematic review. Arthritis Care Res. 2014;66(10):1551–9. This systematic review synthesized empirical evidence on the burden, predictors, and impacts of non-adherence in gout.

    Article  Google Scholar 

  2. 2.

    • Mehat P, Atiquzzaman M, Esdaile JM, et al. Medication non-adherence in systemic lupus erythematosus: a systematic review. Arthritis Care & Research. 2017 (published online 13 January 2017). This systematic review synthesized the data on the burden and determinants of medication non-adherence among SLE patients.

  3. 3.

    Salt E, Frazier S. Adherence to disease modifying anti-rheumatic drugs in rheumatoid arthritis patients: a narrative review of the literature. Orthop Nurs. 2010;29(4):260–75.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Pasma A, van’t Spijker A, Hazes JM, et al. Factors associated with adherence to pharmaceutical treatment for rheumatoid arthritis patients: a systematic review. Semin Arthritis Rheum. 2013;43(1):18–28.

    Article  PubMed  Google Scholar 

  5. 5.

    De Vera MA, Mailman J, Galo JS. Economics of non-adherence to biologic therapies in rheumatoid arthritis. Curr Rheumatol Rep. 2014;16(11):460.

    Article  PubMed  Google Scholar 

  6. 6.

    van den Bemt BJ, Zwikker HE, van den Ende CH. Medication adherence in patients with rheumatoid arthritis: a critical appraisal of the existing literature. Expert Rev Clin Immunol. 2012;8(4):337–51.

    Article  PubMed  Google Scholar 

  7. 7.

    • Marengo MF, Suarez-Almazor ME. Improving treatment adherence in patients with rheumatoid arthritis: what are the options? Int J Clin Rheumatol. 2015;10(5):345–56. This review summarized the recent literature on determinants of adherence, and related interventions, that can improve therapeutic adherence in patients with RA.

    CAS  Article  Google Scholar 

  8. 8.

    Feldman CH, Yazdany J, Guan H, et al. Medication nonadherence is associated with increased subsequent acute care utilization among Medicaid beneficiaries with systemic lupus erythematosus. Arthritis Care Res. 2015;67(12):1712–21.

    CAS  Article  Google Scholar 

  9. 9.

    Julian LJ, Yelin E, Yazdany J, et al. Depression, medication adherence, and service utilization in systemic lupus erythematosus. Arthritis Care Res. 2009;61(2):240–6.

    Article  Google Scholar 

  10. 10.

    Halpern R, Mody RR, Fuldeore MJ, et al. Impact of noncompliance with urate-lowering drug on serum urate and gout-related healthcare costs: administrative claims analysis. Curr Med Res Opin. 2009;25(7):1711–9.

    Article  PubMed  Google Scholar 

  11. 11.

    Contreras-Yáñez I, Cabiedes J, Rull-Gabayet M, et al. Inadequate therapy behavior is associated to disease flares in patients with rheumatoid arthritis who have achieved remission with disease-modifying antirheumatic drugs. Am J Med Sci. 2010;340(4):282–90.

    Article  PubMed  Google Scholar 

  12. 12.

    Sabate E. Adherence to long-term therapies: evidence for action. Geneva, Switzerland: World Health Organization; 2003.

  13. 13.

    Kardas P, Lewek P, Matyjaszczyk M. Determinants of patient adherence: a review of systematic reviews. Front Pharmacol. 2013;4:91.

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Iuga AO, McGuire MJ. Adherence and health care costs. Risk Manag & Healthcare Policy. 2014;7:35–44.

    Google Scholar 

  15. 15.

    Cramer JA, Roy A, Burrell A, et al. Medication compliance and persistence: terminology and definitions. Value Health. 2008;11(1):44–7.

    Article  PubMed  Google Scholar 

  16. 16.

    Hess LM, Raebel MA, Conner DA, et al. Measurement of adherence in pharmacy administrative databases: a proposal for standard definitions and preferred measures. Ann Pharmacother. 2006;40(7–8):1280–8.

    Article  PubMed  Google Scholar 

  17. 17.

    Vrijens B, De Geest S, Hughes DA, et al. A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol. 2012;73(5):691–705.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487–97.

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Urquhart JV, B. New findings about ptaient adherence to prescribed drug dosing regimens: an introduction to pharmionics. Eur J Hospital Phar Sci. 2005;11(5):103–6.

    Google Scholar 

  20. 20.

    Mulherin D, Wong M. Drug survival in rheumatoid arthritis. Rheumatology. 2006;45(9):1178. author reply -9

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Koncz T, Pentek M, Brodszky V, et al. Adherence to biologic DMARD therapies in rheumatoid arthritis. Expert Opin Biol Ther. 2010;10(9):1367–78.

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Treharne GL, Hale A, et al. Drug survival in rheumatoid arthritis—an interesting method but not a measure of adherence or corcodance. Rheumatology. 2006;45:1178–9.

    Article  Google Scholar 

  23. 23.

    Martinez-Santana V, Gonzalez-Sarmiento E, Calleja-Hernandez M, et al. Comparison of drug survival rates for tumor necrosis factor antagonists in rheumatoid arthritis. Patient Pref Adher. 2013;7:719–27.

    Article  Google Scholar 

  24. 24.

    Boonen A, van der Linden SM. The burden of ankylosing spondylitis. J Rheumatol Suppl. 2006;78:4–11.

    PubMed  Google Scholar 

  25. 25.

    Braun J, Sieper J. Ankylosing spondylitis. Lancet. 2007;369(9570):1379–90.

    Article  PubMed  Google Scholar 

  26. 26.

    Feldtkeller E, Khan MA, van der Heijde D, et al. Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatol Int. 2003;23(2):61–6.

    PubMed  Google Scholar 

  27. 27.

    Braun J, van den Berg R, Baraliakos X, et al. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis. 2011;70(6):896–904.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Clegg DO, Clegg DO. Treatment of ankylosing spondylitis. J Rheumatol Suppl. 2006;78:24–31.

    CAS  PubMed  Google Scholar 

  29. 29.

    Ward MM, Deodhar A, Akl EA, et al. American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. Arthritis Rheum. 2015;68(2):282–98.

    Article  Google Scholar 

  30. 30.

    De Klerk E, Van der Linden S. Compliance monitoring of NSAID drug therapy in ankylosing spondylitis, experiences with an electronic monitoring device. Rheumatology. 1996;35(1):60–5.

    Article  Google Scholar 

  31. 31.

    Carmona L, Gómez-Reino JJ. Survival of TNF antagonists in spondylarthritis is better than in rheumatoid arthritis. Data from the Spanish registry BIOBADASER. Arthritis Res Ther. 2006;8(3):R72.

    Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Heiberg MS, Koldingsnes W, Mikkelsen K, et al. The comparative one-year performance of anti-tumor necrosis factor α drugs in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis: results from a longitudinal, observational, multicenter study. Arthritis Care Res. 2008;59(2):234–40.

    CAS  Article  Google Scholar 

  33. 33.

    Pavelka K, Forejtova S, Stolfa J, et al. Anti-TNF therapy of ankylosing spondylitis in clinical practice. Results from the Czech national registry ATTRA. Clin Exp Rheumatol. 2009;27(6):958–63.

    CAS  PubMed  Google Scholar 

  34. 34.

    Arturi P, Schneeberger EE, Sommerfleck F, et al. Adherence to treatment in patients with ankylosing spondylitis. Clin Rheumatol. 2013;32(7):1007–15.

    Article  PubMed  Google Scholar 

  35. 35.

    Betegnie A-L, Gauchet A, Lehmann A, et al. Why do patients with chronic inflammatory rheumatic diseases discontinue their biologics? An assessment of patients’ adherence using a self-report questionnaire. J Rheumatol. 2016;43(4):724–30.

    Article  PubMed  Google Scholar 

  36. 36.

    Lyu R, Govoni M, Ding Q, et al. Treatment persistence among patients with rheumatoid disease (RA, AS, PsA) treated with subcutaneous biologics in Germany. Rheumatol Int. 2016;36(1):143–53.

    Article  PubMed  Google Scholar 

  37. 37.

    Rai SK, Avina-Zubieta JA, McCormick N, et al. The rising prevalence and incidence of gout in British Columbia, Canada: population-based trends from 2000 to 2012. Semin Arthritis Rheum. 2016;46(4):451–6.

    Article  PubMed  Google Scholar 

  38. 38.

    Perez-Ruiz F. Treating to target: a strategy to cure gout. Rheumatology. 2009;48(Suppl 2):ii9–ii14.

    CAS  Article  PubMed  Google Scholar 

  39. 39.

    Zhu Y, Pandya BJ, Choi HK. Comorbidities of gout and hyperuricemia in the US general population: NHANES 2007-2008. Am J Med. 2012;125(7):679–87.e1.

    Article  PubMed  Google Scholar 

  40. 40.

    Khanna D, Khanna PP, Fitzgerald JD, et al. American College of Rheumatology guidelines for management of gout. Part 2: therapy and antiinflammatory prophylaxis of acute gouty arthritis. Arthritis Care Res. 2012;64(10):1447–61.

    CAS  Article  Google Scholar 

  41. 41.

    Zhang W, Doherty M, Bardin T, et al. EULAR evidence based recommendations for gout. Part II: management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2006;65(10):1312–24.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  42. 42.

    McGowan B, Bennett K, Silke C, et al. Adherence and persistence to urate-lowering therapies in the Irish setting. Clin Rheumatol. 2016;35(3):715–21.

    Article  PubMed  Google Scholar 

  43. 43.

    Doherty M, Jansen TL, Nuki G, et al. Gout: why is this curable disease so seldom cured? Ann Rheum Dis. 2012;71(11):1765–70.

    Article  PubMed  Google Scholar 

  44. 44.

    Zandman-Goddard G, Amital H, Shamrayevsky N, et al. Rates of adherence and persistence with allopurinol therapy among gout patients in Israel. Rheumatology. 2013;52(6):1126–31.

    CAS  Article  PubMed  Google Scholar 

  45. 45.

    Setty AR, Choi HK. Psoriatic arthritis epidemiology. Curr Rheumatol Rep. 2007;9(6):449–54.

    Article  PubMed  Google Scholar 

  46. 46.

    Gladman DD, Antoni C, Mease P, et al. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis. 2005;64(2):ii14–7.

    PubMed  PubMed Central  Google Scholar 

  47. 47.

    Gossec L, Smolen JS, Ramiro S, et al. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update. Ann Rheum Dis. 2016;75(3):499–510.

    CAS  Article  PubMed  Google Scholar 

  48. 48.

    Saad AA, Ashcroft DM, Watson KD, et al. Persistence with anti-tumour necrosis factor therapies in patients with psoriatic arthritis: observational study from the British Society of Rheumatology Biologics Register. Arthritis Res Ther. 2009;11(2):R52.

    Article  PubMed  PubMed Central  Google Scholar 

  49. 49.

    Chastek B, Fox KM, Watson C, et al. Etanercept and adalimumab treatment patterns in psoriatic arthritis patients enrolled in a commercial health plan. Adv Ther. 2012;29(8):691–7.

    CAS  Article  PubMed  Google Scholar 

  50. 50.

    Firestein GS, Budd RC, Gabriel SE, et al. Kelley’s textbook of rheumatology: expert consult premium edition. 9th ed. Philadelphia: Saunders; 2012. 2292 p.

    Google Scholar 

  51. 51.

    Cojocaru M, Cojocaru IM, Silosi I, et al. Manifestations of systemic lupus erythematosus. Maedica (Buchar). 2011;6(4):330–6.

    Google Scholar 

  52. 52.

    Klippel JH, Stone JH, White PH. Primer on the rheumatic diseases. Springer Science & Business Media; 2008. 703 p.

  53. 53.

    Feldman CH, Hiraki LT, Liu J, et al. Epidemiology and sociodemographics of systemic lupus erythematosus and lupus nephritis among US adults with Medicaid coverage, 2000-2004. Arthritis Rheum. 2013;65(3):753–63.

    Article  PubMed  PubMed Central  Google Scholar 

  54. 54.

    Bertsias GK, Tektonidou M, Amoura Z, et al. Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis. Ann Rheum Dis. 2012;71(11):1771–82.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  55. 55.

    Aviña-Zubieta JA, Esdaile JM. Chapter 49. Antimalarial medications. In: Wallace D, Hahn BH, editors. Dubois’ lupus erythematosus and related syndromes. 8th ed. Philadelphia: Elsevier Saunders; 2012. p. 601–8.

    Google Scholar 

  56. 56.

    Harrold LR, Andrade SE. Medication adherence of patients with selected rheumatic conditions: a systematic review of the literature. Semin Arthritis Rheum. 2009;38(5):396–402.

    Article  PubMed  Google Scholar 

  57. 57.

    Garcia-Gonzalez A, Richardson M, Garcia Popa-Lisseanu M, et al. Treatment adherence in patients with rheumatoid arthritis and systemic lupus erythematosus. Clin Rheumatol. 2008;27(7):883–9.

    Article  PubMed  Google Scholar 

  58. 58.

    Koneru S, Kocharla L, Higgins GC, et al. Adherence to medications in systemic lupus erythematosus. J Clin Rheumatol. 2008;14(4):195–201.

    PubMed  Google Scholar 

  59. 59.

    Oliveira-Santos M, Verani JF, Klumb EM, et al. Evaluation of adherence to drug treatment in patients with systemic lupus erythematosus in Brazil. Lupus. 2011;20(3):320–9.

    CAS  Article  PubMed  Google Scholar 

  60. 60.

    Abdul-Sattar AB, Abou El Magd SA. Determinants of medication non-adherence in Egyptian patients with systemic lupus erythematosus: Sharkia Governorate. Rheumatol Int. 2015;35(6):1045–51.

  61. 61.

    Prudente LR, Diniz Jde S, Ferreira TX, et al. Medication adherence in patients in treatment for rheumatoid arthritis and systemic lupus erythematosus in a university hospital in Brazil. Patient Pref Adher. 2016;10:863–70.

    Article  Google Scholar 

  62. 62.

    Dugowson CE, Koepsell TD, Voigt LF, et al. Rheumatoid arthritis in women. Incidence rates in group health cooperative, Seattle, Washington, 1987-1989. Arthritis Rheum. 1991;34(12):1502–7.

    CAS  Article  PubMed  Google Scholar 

  63. 63.

    Bykerk VP, Akhavan P, Hazlewood GS, et al. Canadian Rheumatology Association recommendations for pharmacological management of rheumatoid arthritis with traditional and biologic disease-modifying antirheumatic drugs. J Rheumatol. 2012;39(8):1559–82.

    CAS  Article  PubMed  Google Scholar 

  64. 64.

    Singh JA, Furst DE, Bharat A, et al. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res. 2012;64(5):625–39.

    CAS  Article  Google Scholar 

  65. 65.

    Bykerk V, Emery P. Delay in receiving rheumatology care leads to long-term harm. Arthritis Rheum. 2010;62(12):3519–21.

    Article  PubMed  Google Scholar 

  66. 69.

    Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Allaart CF, et al. Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): a randomized, controlled trial. Arthritis Rheum. 2005;52(11):3381–90.

    CAS  Article  PubMed  Google Scholar 

  67. 67.

    Klareskog L, Catrina AI, Paget S. Rheumatoid arthritis. Lancet. 2009;373(9664):659–72.

    CAS  Article  PubMed  Google Scholar 

  68. 68.

    Lard LR, Visser H, Speyer I, et al. Early versus delayed treatment in patients with recent-onset rheumatoid arthritis: comparison of two cohorts who received different treatment strategies. Am J Med. 2001;111(6):446–51.

    CAS  Article  PubMed  Google Scholar 

  69. 69.

    Mottonen T, Hannonen P, Korpela M, et al. Delay to institution of therapy and induction of remission using single-drug or combination-disease-modifying antirheumatic drug therapy in early rheumatoid arthritis. Arthritis Rheum. 2002;46(4):894–8.

    CAS  Article  PubMed  Google Scholar 

  70. 70.

    Quinn MA, Conaghan PG, O’Connor PJ, et al. Very early treatment with infliximab in addition to methotrexate in early, poor-prognosis rheumatoid arthritis reduces magnetic resonance imaging evidence of synovitis and damage, with sustained benefit after infliximab withdrawal: results from a twelve-month randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2005;52(1):27–35.

    CAS  Article  PubMed  Google Scholar 

  71. 71.

    de Achaval S, Suarez-Almazor ME. Treatment adherence to disease-modifying antirheumatic drugs in patients with rheumatoid arthritis and systemic lupus erythematosus. Int J Clin Rheumatol. 2010;5:313–26.

    Article  Google Scholar 

  72. 72.

    Blum MA, Koo D, Doshi JA. Measurement and rates of persistence with and adherence to biologics for rheumatoid arthritis: a systematic review. Clin Ther. 2011;33(7):901–13.

    Article  PubMed  Google Scholar 

  73. 73.

    Tang B, Rahman M, Waters HC, et al. Treatment persistence with adalimumab, etanercept, or infliximab in combination with methotrexate and the effects on health care costs in patients with rheumatoid arthritis. Clin Ther. 2008;30(7):1375–84.

    CAS  Article  PubMed  Google Scholar 

  74. 74.

    Borah BJ, Huang X, Zarotsky V, et al. Trends in RA patients’ adherence to subcutaneous anti-TNF therapies and costs. Curr Med Res Opin. 2009;25(6):1365–77.

    Article  PubMed  Google Scholar 

  75. 75.

    Pasma A, Schenk C, Timman R, et al. Does non-adherence to DMARDs influence hospital-related healthcare costs for early arthritis in the first year of treatment? PLoS One. 2017;12(2):e0171070.

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Mary A. De Vera.

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Funding and Grant Support

Dr. De Vera is the Canada Research Chair in Medication Adherence, Utilization, and Outcomes and is a recipient of The Arthritis Society Network Scholar Award and Michael Smith Foundation for Health Research Scholar Award.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Health Economics and Quality of Life

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Campbell, N.K.J., Saadeldin, K. & De Vera, M.A. The Duality of Economic Issues With Medication Non-adherence in Patients With Inflammatory Arthritis. Curr Rheumatol Rep 19, 66 (2017). https://doi.org/10.1007/s11926-017-0691-3

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Keywords

  • Inflammatory arthritis
  • Adherence
  • Patient compliance
  • Health economics
  • Costs