Studies: Adherence to CF, UC/Crohn’s Meds Lowered Hospitalizations, Costs

Patients who were adherent to treatment regimens for cystic fibrosis, ulcerative colitis, and Crohn’s disease were less likely to be hospitalized than non-adherent patients, according to two studies conducted by AllianceRx Walgreens Prime and presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) in May 2022.

Cystic fibrosis is a progressive, genetic disease that causes persistent lung infections and limits the ability to breathe over time. Ulcerative colitis and Crohn’s disease are two types of inflammatory bowel disease (IBD), chronic conditions causing inflammation of the gastrointestinal tract. Biologic medications are often prescribed to help manage these conditions.

Edward Witt, Ph.D.

“For payers and providers, medication adherence is a key factor for reducing costs and improving quality of care,” Edward Witt, Ph.D., manager, health analytics, research and reporting at Walgreens, told Formulary Watch. “The average age of patients with ulcerative colitis and Crohn’s disease is younger relative to other chronic inflammatory conditions such as rheumatoid arthritis. The research findings suggest adherence to treatments for these conditions could improve symptoms and avoid disruptions such as hospitalizations. As such, this would allow these patients to lead happier and more productive work and home lives.”

Both studies were retrospective analyses of a de-identified commercial claims database consisting of a national sample of patients. Researchers used pharmacy and medical claims data to determine patients’ adherence to their medication therapies and compare it to outcomes. Adherence was measured by using a proportion of days covered (PDC) metric among patients who had medical claims with ICD-10 codes for their respective study during 2019. Researchers examined outcomes including hospitalizations, inpatient bed days and inpatient costs.

For the cystic fibrosis, researchers found that patients prescribed CF transmembrane conductance regulator modulator (CFTRm) medications, which address the underlying cause of the disease, were adherent to their medication and were significantly less likely to be hospitalized. Adherent patients (22.1%) were significantly less likely to be hospitalized than non-adherent patients. Among hospitalized patients, the data showed a pattern such that inpatient costs were lower, and days stayed in the hospital were shorter, but these differences were not statistically significant, according to the poster presented at ISPOR.

A total of 598 patients met the criteria for the study. The most commonly used medication was Symdeko (tezacaftor/ivacaftor and ivacaftor) developed by Vertex. Of those patients who were not adherent, 37.6% were hospitalized compared with 22.0% of those who were adherent. Median total inpatient costs for adherent patients were $64,736 compared with a median of $104,085 for nonadherent patients.

For the Crohn’s and ulcerative colitis study, 8,849 and 3,106 patients had sufficient data to calculate proportion of days covered and met diagnostic criteria for Crohn’s and UC, respectively. About two out of three patients were adherent to their medications, with the most commonly used medication being AbbVie’s Humira (adalimumab), followed by Janssen’s Stelara (ustekinumab). For ulcerative colitis, adherence was 66.1% and for Crohn’s, adherence was 64.6%.

Nishita Hira, Pharm.D.

Among adherent patients with Crohn’s, 14.4% were hospitalized, compared with 21.6% of patients where weren’t adherent. Among patients with ulcerative colitis, 9.6% were hospitalized compared with 18.1% of patients who weren’t adherent.

Renee Baiano, Pharm.D.

This resulted in higher inpatients costs for patients who weren’t adherence to medications. For patients with Crohn’s costs for patients who were not adherent were $49,278 compared with those who were, and for ulcerative colitis, costs were $47,700 for those where not adherent versus $23,390 for those who were.

“Prior research has shown non-adherence to cystic fibrosis therapies leads to unfavorable health outcomes,” Nishita Hira, Pharm.D., clinical program manager, AllianceRx Walgreens Prime, said by email. “Medication adherence is key to producing favorable health outcomes. Specialty pharmacy-led clinical patient management programs, which assist patients with medication access and provide continued adherence support, can play an important role in lowering healthcare costs,” Hira said.

Although the study didn’t look at barriers to adherence, Hira said several factors contribute to patient adherence, including: patient knowledge of condition and medications used to treat condition, timely pharmacist counseling on patient-reported side effects or adherence barriers (to prevent interruption of therapy), and family/caregiver support. Factors that contribute to non-adherence include: financial issues, side effects, complexity of regimen (i.e., multiple medications), and therapy burden (i.e., time it takes to administer medications).

“Identifying barriers to adherence and educating patients on the importance of taking their medication can increase the patient’s chance at disease improvement,” said Renee Baiano, Pharm.D., clinical program manager at AllianceRx Walgreens Prime. “Whether it is helping patients take their medication the right way or notifying their prescriber about new adverse events, a specialty pharmacist plays a vital role in helping patients stay on therapy.”