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Adherence to Inhaled Medications and its Effect on Healthcare Utilization and Costs Among High-Grade Chronic Obstructive Pulmonary Disease Patients

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.

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Acknowledgements

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.

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Authors and Affiliations

Authors

Contributions

J-AK contributed to the study concept and design, acquisition, analysis and interpretation of data for the study, drafted and revised the manuscript critically for important intellectual content, and provided statistical expertise. MKL contributed to the interpretation of the data for the study and revised the manuscript critically for important intellectual content. KK contributed to the interpretation of data for the study and revised the manuscript critically for important intellectual content. J-HP contributed to the data analysis for the study and revised the manuscript critically for important intellectual content. CKR contributed to the study concept and design, and interpretation of the data for the study and revised the manuscript critically for important intellectual content. All authors approved the final approval of the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Chin Kook Rhee.

Ethics declarations

Ethics Approval and Consent to Participate

Ethics Committee of Seoul St. Mary’s Hospital approved the present study. The requirement for informed consent from the patients studied was waived by the ethical review board by Seoul St. Mary’s Hospital, the Catholic University of Korea.

Conflict of Interest

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.

Funding

No funding was provided for this study.

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Kim, JA., Lim, M.K., Kim, K. et al. Adherence to Inhaled Medications and its Effect on Healthcare Utilization and Costs Among High-Grade Chronic Obstructive Pulmonary Disease Patients. Clin Drug Investig 38, 333–340 (2018). https://doi.org/10.1007/s40261-017-0612-2

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  • DOI: https://doi.org/10.1007/s40261-017-0612-2