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Snapshot of medication adherence in chronic medication
in older populations application of common protocol
among three European cohorts
E Menditto C Cahir M Aza BP Blou S Malo D Bruzzese FG Rubio P Kardas A Pardos-Torres
Royal College of Surgeons in Ireland
Center of Pharmacoeconomics University of Naples Italy
Action Group A1 Prescription amp Adherence to medical plans
Medication Adherence
bull ABC Taxonomy of Adherence -ldquoas the process by which patients take their medication as prescribedrdquo bull initiation implementation discontinuation
bull Medication adherence is poor and a major public
health problem in Western countries
bull Older people experience greater morbidity with a corresponding increase in medication utilisation and are at an increased risk of non-adherence
Collection of Database Specifications
EpiChron HSE-PCRS-TILDA CE-LHU
Aims
The aims of this study were to bull Assess the feasibility of performing a collaborative
cross-country comparison of medication adherence based on pooled outpatient pharmacy dispensing data
bull To compare medication adherence rates in three highly prevalent chronic conditions across three different European cohorts
Methods
Databases Centre of Pharmacoeconomics and Drug utilization (CIRFF) University of Naples - Federico II Recognized as a Research Centre of Regional Relevance in Campania Region performing analysis on Regional Informative Health System (59 M inhabitants)
Aragoacuten health sciences institute (IACS) EpiChron Research Group on Chronic Diseases This group holds the EpiChron Cohort containing all relevant demographic clinical and pharmaceutical and health outcomes information of patients living in Aragoacuten (13 M inhabitants)
Royal College of Surgeons in Ireland Health Research Board (HRB) Research Leaders Award in quality and safety in medication management- Health Services Executive Primary Care Reimbursement Services (HSE-PCRS) General Medical card Scheme (GMS) pharmacy claims data (17 M people)
Flow-chart of the process in the cross-country study on medication adherence
IDENTIFICATION OF MINIMUM COMMON DATA SET
DEFINITION OF COMMON PROTOCOL ANALYSIS
SCRIPTS IMPLEMENTED AT LOCAL LEVEL
COUNTRYrsquoS INDIVIDUAL OUTCOME PARAMETER ESTIMATES
POOLING DATA IN META - ANALYSIS
How do partners collaborate in multi-database studies
Data Definition Form (DDF) describing the information contained in the data sources used in the project
Metrics Definition Form (MDF) describing all issues needing consensus among partners
Pooled estimates were obtained using a meta-analytical approach treating each country as a
different study
Drug Categories
ATC V DRUG Days of Therapy (DOTs)
M05BA04 Alendronate DDDs
M05BA06 Ibandronate DDDs
M05BA07 Risedronate DDDs
M05BB03 Alendronate + Vit D DDDs
C10AA01 simvastatin Pills
C10AA05 Atorvastatin Pills
C10AA03 Pravastatin Pills
C10AA07 Rosuvastatin Pills
C10AA02 Lovastatin Pills
A10BA Biguanides Pillsdeg
A10BB Sulfonylureas Pillsdeg
A10BF Alpha glucosidase inhibitors Pillsdeg
A10BG Thiazolidinediones Pillsdeg
A10BH Dipeptidyl peptidase 4 (DPP-4) inhibitors Pillsdeg
A10BX Other blood glucose lowering drugs excl insulins Pillsdeg
WHO Collaborating Centre for Drug Statistics Methodology Introduction to drug utilization research World Health Organization 2003 OlsquoShea MP Teeling Bennett K An observational study examining the effect of comorbidity on the rates of persistence and adherence to newly initiated oral anti‐hyperglycaemic agents Pharmacoepidemiology and drug safety 2013
Study Population
July 2010 December 2010
December 2011
FOLLOW-UP 12 months
January-June 2010
Study Population
Wash out
- Interrupters
censoring
Older people ge 65 years
First_prescription
Measuring Implementation
Implementation was quantified by the Medication Possession Ratio (MPR) a standard method1 of evaluating drug adherence defined as the number of dispensed therapy units (Defined Daily Doses) divided by the number of assumed prescription periods during the study period
100 sum(days supplied)365
1 ISPOR Medication Compliance amp Persistence Special Interest Group httpwwwispororgsigsMCP_accomplishmentsaspdefinition
The measure was dichotomized and subjects with a MPR ge 80 were classified as adherent to their treatment (lt 80 non-adherent)
Measuring Discontinuation
PERSISTENT
Index date
Index date
x Gap lt 60 days
Gap lt 60 days Gap lt 60 days Gap lt 60 days
End of the study
Drug refill Drug refill
Drug refill Drug refill Drug refill
Discontinuation date
Time to discontinuationdeg
NON PERSISTENT
Gap gt 60 days
degSwitching products within index medication classes was not considered as an interruption
Data Synthesis
bull Implementation and discontinuation rates were estimated by age and gender at the local level in each country
bull Pooled estimates using a meta-analytical approach
bull Random-effects model -anticipated heterogeneity
bull The effect of gender and age was assessed by
computing pooled odds ratios (OR) with 95 confidence intervals (95 CI)
Results
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
Proportion with poor implementation (MPRlt80) in the three European cohorts
52
61
30
Proportion discontinued treatment in the three European cohorts
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
55
60
46
Implementation discontinuation and age bull Non-adherence (MPR lt80) significantly higher for
patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 143 (95 CI 112 183) for antihyperlipidemics
ndash OR 141 (95 CI 117 170) for antiosteoporotics
ndash OR 163 (95 CI 107 247) for oral antidiabetics
bull Non-persistent (gt60 day gap) significantly higher for patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 136 (95 CI 111 168) for antihyperlipidemics
ndash OR 145 95 CI 125 170 for antiosteoporotics
ndash OR 150 95 CI 126 178 for oral antidiabetics
Limitations
bull Criteria simplified to achieve consensus among countries
bull Core data set- lack of clinical and health outcome information
bull Different population cohorts within the 3 countries
bull MPR- over estimate adherence arbitrary cut-off
Conclusion What is already known about this topic
bull Medication non-adherence is a major problem for healthcare systems
bull Pharmacy re-fill data can be used to evaluate adherence to chronic medication
What this study adds
bull Rates of non-adherence to medication vary among countries Italy had the
highest of non-adherence and Ireland had the lowest
bull It is possible to apply a harmonised method of data extraction and analysis across
Europe to compare medication-taking behavior at a cross-country level
bull Database networks present an opportunity for a better understanding of
medication taking behaviour and healthcare management and comparison of
healthcare policies across different settings
Action Group A1 Prescription amp Adherence to medical plans
Medication Adherence
bull ABC Taxonomy of Adherence -ldquoas the process by which patients take their medication as prescribedrdquo bull initiation implementation discontinuation
bull Medication adherence is poor and a major public
health problem in Western countries
bull Older people experience greater morbidity with a corresponding increase in medication utilisation and are at an increased risk of non-adherence
Collection of Database Specifications
EpiChron HSE-PCRS-TILDA CE-LHU
Aims
The aims of this study were to bull Assess the feasibility of performing a collaborative
cross-country comparison of medication adherence based on pooled outpatient pharmacy dispensing data
bull To compare medication adherence rates in three highly prevalent chronic conditions across three different European cohorts
Methods
Databases Centre of Pharmacoeconomics and Drug utilization (CIRFF) University of Naples - Federico II Recognized as a Research Centre of Regional Relevance in Campania Region performing analysis on Regional Informative Health System (59 M inhabitants)
Aragoacuten health sciences institute (IACS) EpiChron Research Group on Chronic Diseases This group holds the EpiChron Cohort containing all relevant demographic clinical and pharmaceutical and health outcomes information of patients living in Aragoacuten (13 M inhabitants)
Royal College of Surgeons in Ireland Health Research Board (HRB) Research Leaders Award in quality and safety in medication management- Health Services Executive Primary Care Reimbursement Services (HSE-PCRS) General Medical card Scheme (GMS) pharmacy claims data (17 M people)
Flow-chart of the process in the cross-country study on medication adherence
IDENTIFICATION OF MINIMUM COMMON DATA SET
DEFINITION OF COMMON PROTOCOL ANALYSIS
SCRIPTS IMPLEMENTED AT LOCAL LEVEL
COUNTRYrsquoS INDIVIDUAL OUTCOME PARAMETER ESTIMATES
POOLING DATA IN META - ANALYSIS
How do partners collaborate in multi-database studies
Data Definition Form (DDF) describing the information contained in the data sources used in the project
Metrics Definition Form (MDF) describing all issues needing consensus among partners
Pooled estimates were obtained using a meta-analytical approach treating each country as a
different study
Drug Categories
ATC V DRUG Days of Therapy (DOTs)
M05BA04 Alendronate DDDs
M05BA06 Ibandronate DDDs
M05BA07 Risedronate DDDs
M05BB03 Alendronate + Vit D DDDs
C10AA01 simvastatin Pills
C10AA05 Atorvastatin Pills
C10AA03 Pravastatin Pills
C10AA07 Rosuvastatin Pills
C10AA02 Lovastatin Pills
A10BA Biguanides Pillsdeg
A10BB Sulfonylureas Pillsdeg
A10BF Alpha glucosidase inhibitors Pillsdeg
A10BG Thiazolidinediones Pillsdeg
A10BH Dipeptidyl peptidase 4 (DPP-4) inhibitors Pillsdeg
A10BX Other blood glucose lowering drugs excl insulins Pillsdeg
WHO Collaborating Centre for Drug Statistics Methodology Introduction to drug utilization research World Health Organization 2003 OlsquoShea MP Teeling Bennett K An observational study examining the effect of comorbidity on the rates of persistence and adherence to newly initiated oral anti‐hyperglycaemic agents Pharmacoepidemiology and drug safety 2013
Study Population
July 2010 December 2010
December 2011
FOLLOW-UP 12 months
January-June 2010
Study Population
Wash out
- Interrupters
censoring
Older people ge 65 years
First_prescription
Measuring Implementation
Implementation was quantified by the Medication Possession Ratio (MPR) a standard method1 of evaluating drug adherence defined as the number of dispensed therapy units (Defined Daily Doses) divided by the number of assumed prescription periods during the study period
100 sum(days supplied)365
1 ISPOR Medication Compliance amp Persistence Special Interest Group httpwwwispororgsigsMCP_accomplishmentsaspdefinition
The measure was dichotomized and subjects with a MPR ge 80 were classified as adherent to their treatment (lt 80 non-adherent)
Measuring Discontinuation
PERSISTENT
Index date
Index date
x Gap lt 60 days
Gap lt 60 days Gap lt 60 days Gap lt 60 days
End of the study
Drug refill Drug refill
Drug refill Drug refill Drug refill
Discontinuation date
Time to discontinuationdeg
NON PERSISTENT
Gap gt 60 days
degSwitching products within index medication classes was not considered as an interruption
Data Synthesis
bull Implementation and discontinuation rates were estimated by age and gender at the local level in each country
bull Pooled estimates using a meta-analytical approach
bull Random-effects model -anticipated heterogeneity
bull The effect of gender and age was assessed by
computing pooled odds ratios (OR) with 95 confidence intervals (95 CI)
Results
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
Proportion with poor implementation (MPRlt80) in the three European cohorts
52
61
30
Proportion discontinued treatment in the three European cohorts
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
55
60
46
Implementation discontinuation and age bull Non-adherence (MPR lt80) significantly higher for
patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 143 (95 CI 112 183) for antihyperlipidemics
ndash OR 141 (95 CI 117 170) for antiosteoporotics
ndash OR 163 (95 CI 107 247) for oral antidiabetics
bull Non-persistent (gt60 day gap) significantly higher for patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 136 (95 CI 111 168) for antihyperlipidemics
ndash OR 145 95 CI 125 170 for antiosteoporotics
ndash OR 150 95 CI 126 178 for oral antidiabetics
Limitations
bull Criteria simplified to achieve consensus among countries
bull Core data set- lack of clinical and health outcome information
bull Different population cohorts within the 3 countries
bull MPR- over estimate adherence arbitrary cut-off
Conclusion What is already known about this topic
bull Medication non-adherence is a major problem for healthcare systems
bull Pharmacy re-fill data can be used to evaluate adherence to chronic medication
What this study adds
bull Rates of non-adherence to medication vary among countries Italy had the
highest of non-adherence and Ireland had the lowest
bull It is possible to apply a harmonised method of data extraction and analysis across
Europe to compare medication-taking behavior at a cross-country level
bull Database networks present an opportunity for a better understanding of
medication taking behaviour and healthcare management and comparison of
healthcare policies across different settings
Medication Adherence
bull ABC Taxonomy of Adherence -ldquoas the process by which patients take their medication as prescribedrdquo bull initiation implementation discontinuation
bull Medication adherence is poor and a major public
health problem in Western countries
bull Older people experience greater morbidity with a corresponding increase in medication utilisation and are at an increased risk of non-adherence
Collection of Database Specifications
EpiChron HSE-PCRS-TILDA CE-LHU
Aims
The aims of this study were to bull Assess the feasibility of performing a collaborative
cross-country comparison of medication adherence based on pooled outpatient pharmacy dispensing data
bull To compare medication adherence rates in three highly prevalent chronic conditions across three different European cohorts
Methods
Databases Centre of Pharmacoeconomics and Drug utilization (CIRFF) University of Naples - Federico II Recognized as a Research Centre of Regional Relevance in Campania Region performing analysis on Regional Informative Health System (59 M inhabitants)
Aragoacuten health sciences institute (IACS) EpiChron Research Group on Chronic Diseases This group holds the EpiChron Cohort containing all relevant demographic clinical and pharmaceutical and health outcomes information of patients living in Aragoacuten (13 M inhabitants)
Royal College of Surgeons in Ireland Health Research Board (HRB) Research Leaders Award in quality and safety in medication management- Health Services Executive Primary Care Reimbursement Services (HSE-PCRS) General Medical card Scheme (GMS) pharmacy claims data (17 M people)
Flow-chart of the process in the cross-country study on medication adherence
IDENTIFICATION OF MINIMUM COMMON DATA SET
DEFINITION OF COMMON PROTOCOL ANALYSIS
SCRIPTS IMPLEMENTED AT LOCAL LEVEL
COUNTRYrsquoS INDIVIDUAL OUTCOME PARAMETER ESTIMATES
POOLING DATA IN META - ANALYSIS
How do partners collaborate in multi-database studies
Data Definition Form (DDF) describing the information contained in the data sources used in the project
Metrics Definition Form (MDF) describing all issues needing consensus among partners
Pooled estimates were obtained using a meta-analytical approach treating each country as a
different study
Drug Categories
ATC V DRUG Days of Therapy (DOTs)
M05BA04 Alendronate DDDs
M05BA06 Ibandronate DDDs
M05BA07 Risedronate DDDs
M05BB03 Alendronate + Vit D DDDs
C10AA01 simvastatin Pills
C10AA05 Atorvastatin Pills
C10AA03 Pravastatin Pills
C10AA07 Rosuvastatin Pills
C10AA02 Lovastatin Pills
A10BA Biguanides Pillsdeg
A10BB Sulfonylureas Pillsdeg
A10BF Alpha glucosidase inhibitors Pillsdeg
A10BG Thiazolidinediones Pillsdeg
A10BH Dipeptidyl peptidase 4 (DPP-4) inhibitors Pillsdeg
A10BX Other blood glucose lowering drugs excl insulins Pillsdeg
WHO Collaborating Centre for Drug Statistics Methodology Introduction to drug utilization research World Health Organization 2003 OlsquoShea MP Teeling Bennett K An observational study examining the effect of comorbidity on the rates of persistence and adherence to newly initiated oral anti‐hyperglycaemic agents Pharmacoepidemiology and drug safety 2013
Study Population
July 2010 December 2010
December 2011
FOLLOW-UP 12 months
January-June 2010
Study Population
Wash out
- Interrupters
censoring
Older people ge 65 years
First_prescription
Measuring Implementation
Implementation was quantified by the Medication Possession Ratio (MPR) a standard method1 of evaluating drug adherence defined as the number of dispensed therapy units (Defined Daily Doses) divided by the number of assumed prescription periods during the study period
100 sum(days supplied)365
1 ISPOR Medication Compliance amp Persistence Special Interest Group httpwwwispororgsigsMCP_accomplishmentsaspdefinition
The measure was dichotomized and subjects with a MPR ge 80 were classified as adherent to their treatment (lt 80 non-adherent)
Measuring Discontinuation
PERSISTENT
Index date
Index date
x Gap lt 60 days
Gap lt 60 days Gap lt 60 days Gap lt 60 days
End of the study
Drug refill Drug refill
Drug refill Drug refill Drug refill
Discontinuation date
Time to discontinuationdeg
NON PERSISTENT
Gap gt 60 days
degSwitching products within index medication classes was not considered as an interruption
Data Synthesis
bull Implementation and discontinuation rates were estimated by age and gender at the local level in each country
bull Pooled estimates using a meta-analytical approach
bull Random-effects model -anticipated heterogeneity
bull The effect of gender and age was assessed by
computing pooled odds ratios (OR) with 95 confidence intervals (95 CI)
Results
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
Proportion with poor implementation (MPRlt80) in the three European cohorts
52
61
30
Proportion discontinued treatment in the three European cohorts
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
55
60
46
Implementation discontinuation and age bull Non-adherence (MPR lt80) significantly higher for
patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 143 (95 CI 112 183) for antihyperlipidemics
ndash OR 141 (95 CI 117 170) for antiosteoporotics
ndash OR 163 (95 CI 107 247) for oral antidiabetics
bull Non-persistent (gt60 day gap) significantly higher for patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 136 (95 CI 111 168) for antihyperlipidemics
ndash OR 145 95 CI 125 170 for antiosteoporotics
ndash OR 150 95 CI 126 178 for oral antidiabetics
Limitations
bull Criteria simplified to achieve consensus among countries
bull Core data set- lack of clinical and health outcome information
bull Different population cohorts within the 3 countries
bull MPR- over estimate adherence arbitrary cut-off
Conclusion What is already known about this topic
bull Medication non-adherence is a major problem for healthcare systems
bull Pharmacy re-fill data can be used to evaluate adherence to chronic medication
What this study adds
bull Rates of non-adherence to medication vary among countries Italy had the
highest of non-adherence and Ireland had the lowest
bull It is possible to apply a harmonised method of data extraction and analysis across
Europe to compare medication-taking behavior at a cross-country level
bull Database networks present an opportunity for a better understanding of
medication taking behaviour and healthcare management and comparison of
healthcare policies across different settings
Collection of Database Specifications
EpiChron HSE-PCRS-TILDA CE-LHU
Aims
The aims of this study were to bull Assess the feasibility of performing a collaborative
cross-country comparison of medication adherence based on pooled outpatient pharmacy dispensing data
bull To compare medication adherence rates in three highly prevalent chronic conditions across three different European cohorts
Methods
Databases Centre of Pharmacoeconomics and Drug utilization (CIRFF) University of Naples - Federico II Recognized as a Research Centre of Regional Relevance in Campania Region performing analysis on Regional Informative Health System (59 M inhabitants)
Aragoacuten health sciences institute (IACS) EpiChron Research Group on Chronic Diseases This group holds the EpiChron Cohort containing all relevant demographic clinical and pharmaceutical and health outcomes information of patients living in Aragoacuten (13 M inhabitants)
Royal College of Surgeons in Ireland Health Research Board (HRB) Research Leaders Award in quality and safety in medication management- Health Services Executive Primary Care Reimbursement Services (HSE-PCRS) General Medical card Scheme (GMS) pharmacy claims data (17 M people)
Flow-chart of the process in the cross-country study on medication adherence
IDENTIFICATION OF MINIMUM COMMON DATA SET
DEFINITION OF COMMON PROTOCOL ANALYSIS
SCRIPTS IMPLEMENTED AT LOCAL LEVEL
COUNTRYrsquoS INDIVIDUAL OUTCOME PARAMETER ESTIMATES
POOLING DATA IN META - ANALYSIS
How do partners collaborate in multi-database studies
Data Definition Form (DDF) describing the information contained in the data sources used in the project
Metrics Definition Form (MDF) describing all issues needing consensus among partners
Pooled estimates were obtained using a meta-analytical approach treating each country as a
different study
Drug Categories
ATC V DRUG Days of Therapy (DOTs)
M05BA04 Alendronate DDDs
M05BA06 Ibandronate DDDs
M05BA07 Risedronate DDDs
M05BB03 Alendronate + Vit D DDDs
C10AA01 simvastatin Pills
C10AA05 Atorvastatin Pills
C10AA03 Pravastatin Pills
C10AA07 Rosuvastatin Pills
C10AA02 Lovastatin Pills
A10BA Biguanides Pillsdeg
A10BB Sulfonylureas Pillsdeg
A10BF Alpha glucosidase inhibitors Pillsdeg
A10BG Thiazolidinediones Pillsdeg
A10BH Dipeptidyl peptidase 4 (DPP-4) inhibitors Pillsdeg
A10BX Other blood glucose lowering drugs excl insulins Pillsdeg
WHO Collaborating Centre for Drug Statistics Methodology Introduction to drug utilization research World Health Organization 2003 OlsquoShea MP Teeling Bennett K An observational study examining the effect of comorbidity on the rates of persistence and adherence to newly initiated oral anti‐hyperglycaemic agents Pharmacoepidemiology and drug safety 2013
Study Population
July 2010 December 2010
December 2011
FOLLOW-UP 12 months
January-June 2010
Study Population
Wash out
- Interrupters
censoring
Older people ge 65 years
First_prescription
Measuring Implementation
Implementation was quantified by the Medication Possession Ratio (MPR) a standard method1 of evaluating drug adherence defined as the number of dispensed therapy units (Defined Daily Doses) divided by the number of assumed prescription periods during the study period
100 sum(days supplied)365
1 ISPOR Medication Compliance amp Persistence Special Interest Group httpwwwispororgsigsMCP_accomplishmentsaspdefinition
The measure was dichotomized and subjects with a MPR ge 80 were classified as adherent to their treatment (lt 80 non-adherent)
Measuring Discontinuation
PERSISTENT
Index date
Index date
x Gap lt 60 days
Gap lt 60 days Gap lt 60 days Gap lt 60 days
End of the study
Drug refill Drug refill
Drug refill Drug refill Drug refill
Discontinuation date
Time to discontinuationdeg
NON PERSISTENT
Gap gt 60 days
degSwitching products within index medication classes was not considered as an interruption
Data Synthesis
bull Implementation and discontinuation rates were estimated by age and gender at the local level in each country
bull Pooled estimates using a meta-analytical approach
bull Random-effects model -anticipated heterogeneity
bull The effect of gender and age was assessed by
computing pooled odds ratios (OR) with 95 confidence intervals (95 CI)
Results
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
Proportion with poor implementation (MPRlt80) in the three European cohorts
52
61
30
Proportion discontinued treatment in the three European cohorts
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
55
60
46
Implementation discontinuation and age bull Non-adherence (MPR lt80) significantly higher for
patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 143 (95 CI 112 183) for antihyperlipidemics
ndash OR 141 (95 CI 117 170) for antiosteoporotics
ndash OR 163 (95 CI 107 247) for oral antidiabetics
bull Non-persistent (gt60 day gap) significantly higher for patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 136 (95 CI 111 168) for antihyperlipidemics
ndash OR 145 95 CI 125 170 for antiosteoporotics
ndash OR 150 95 CI 126 178 for oral antidiabetics
Limitations
bull Criteria simplified to achieve consensus among countries
bull Core data set- lack of clinical and health outcome information
bull Different population cohorts within the 3 countries
bull MPR- over estimate adherence arbitrary cut-off
Conclusion What is already known about this topic
bull Medication non-adherence is a major problem for healthcare systems
bull Pharmacy re-fill data can be used to evaluate adherence to chronic medication
What this study adds
bull Rates of non-adherence to medication vary among countries Italy had the
highest of non-adherence and Ireland had the lowest
bull It is possible to apply a harmonised method of data extraction and analysis across
Europe to compare medication-taking behavior at a cross-country level
bull Database networks present an opportunity for a better understanding of
medication taking behaviour and healthcare management and comparison of
healthcare policies across different settings
Aims
The aims of this study were to bull Assess the feasibility of performing a collaborative
cross-country comparison of medication adherence based on pooled outpatient pharmacy dispensing data
bull To compare medication adherence rates in three highly prevalent chronic conditions across three different European cohorts
Methods
Databases Centre of Pharmacoeconomics and Drug utilization (CIRFF) University of Naples - Federico II Recognized as a Research Centre of Regional Relevance in Campania Region performing analysis on Regional Informative Health System (59 M inhabitants)
Aragoacuten health sciences institute (IACS) EpiChron Research Group on Chronic Diseases This group holds the EpiChron Cohort containing all relevant demographic clinical and pharmaceutical and health outcomes information of patients living in Aragoacuten (13 M inhabitants)
Royal College of Surgeons in Ireland Health Research Board (HRB) Research Leaders Award in quality and safety in medication management- Health Services Executive Primary Care Reimbursement Services (HSE-PCRS) General Medical card Scheme (GMS) pharmacy claims data (17 M people)
Flow-chart of the process in the cross-country study on medication adherence
IDENTIFICATION OF MINIMUM COMMON DATA SET
DEFINITION OF COMMON PROTOCOL ANALYSIS
SCRIPTS IMPLEMENTED AT LOCAL LEVEL
COUNTRYrsquoS INDIVIDUAL OUTCOME PARAMETER ESTIMATES
POOLING DATA IN META - ANALYSIS
How do partners collaborate in multi-database studies
Data Definition Form (DDF) describing the information contained in the data sources used in the project
Metrics Definition Form (MDF) describing all issues needing consensus among partners
Pooled estimates were obtained using a meta-analytical approach treating each country as a
different study
Drug Categories
ATC V DRUG Days of Therapy (DOTs)
M05BA04 Alendronate DDDs
M05BA06 Ibandronate DDDs
M05BA07 Risedronate DDDs
M05BB03 Alendronate + Vit D DDDs
C10AA01 simvastatin Pills
C10AA05 Atorvastatin Pills
C10AA03 Pravastatin Pills
C10AA07 Rosuvastatin Pills
C10AA02 Lovastatin Pills
A10BA Biguanides Pillsdeg
A10BB Sulfonylureas Pillsdeg
A10BF Alpha glucosidase inhibitors Pillsdeg
A10BG Thiazolidinediones Pillsdeg
A10BH Dipeptidyl peptidase 4 (DPP-4) inhibitors Pillsdeg
A10BX Other blood glucose lowering drugs excl insulins Pillsdeg
WHO Collaborating Centre for Drug Statistics Methodology Introduction to drug utilization research World Health Organization 2003 OlsquoShea MP Teeling Bennett K An observational study examining the effect of comorbidity on the rates of persistence and adherence to newly initiated oral anti‐hyperglycaemic agents Pharmacoepidemiology and drug safety 2013
Study Population
July 2010 December 2010
December 2011
FOLLOW-UP 12 months
January-June 2010
Study Population
Wash out
- Interrupters
censoring
Older people ge 65 years
First_prescription
Measuring Implementation
Implementation was quantified by the Medication Possession Ratio (MPR) a standard method1 of evaluating drug adherence defined as the number of dispensed therapy units (Defined Daily Doses) divided by the number of assumed prescription periods during the study period
100 sum(days supplied)365
1 ISPOR Medication Compliance amp Persistence Special Interest Group httpwwwispororgsigsMCP_accomplishmentsaspdefinition
The measure was dichotomized and subjects with a MPR ge 80 were classified as adherent to their treatment (lt 80 non-adherent)
Measuring Discontinuation
PERSISTENT
Index date
Index date
x Gap lt 60 days
Gap lt 60 days Gap lt 60 days Gap lt 60 days
End of the study
Drug refill Drug refill
Drug refill Drug refill Drug refill
Discontinuation date
Time to discontinuationdeg
NON PERSISTENT
Gap gt 60 days
degSwitching products within index medication classes was not considered as an interruption
Data Synthesis
bull Implementation and discontinuation rates were estimated by age and gender at the local level in each country
bull Pooled estimates using a meta-analytical approach
bull Random-effects model -anticipated heterogeneity
bull The effect of gender and age was assessed by
computing pooled odds ratios (OR) with 95 confidence intervals (95 CI)
Results
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
Proportion with poor implementation (MPRlt80) in the three European cohorts
52
61
30
Proportion discontinued treatment in the three European cohorts
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
55
60
46
Implementation discontinuation and age bull Non-adherence (MPR lt80) significantly higher for
patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 143 (95 CI 112 183) for antihyperlipidemics
ndash OR 141 (95 CI 117 170) for antiosteoporotics
ndash OR 163 (95 CI 107 247) for oral antidiabetics
bull Non-persistent (gt60 day gap) significantly higher for patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 136 (95 CI 111 168) for antihyperlipidemics
ndash OR 145 95 CI 125 170 for antiosteoporotics
ndash OR 150 95 CI 126 178 for oral antidiabetics
Limitations
bull Criteria simplified to achieve consensus among countries
bull Core data set- lack of clinical and health outcome information
bull Different population cohorts within the 3 countries
bull MPR- over estimate adherence arbitrary cut-off
Conclusion What is already known about this topic
bull Medication non-adherence is a major problem for healthcare systems
bull Pharmacy re-fill data can be used to evaluate adherence to chronic medication
What this study adds
bull Rates of non-adherence to medication vary among countries Italy had the
highest of non-adherence and Ireland had the lowest
bull It is possible to apply a harmonised method of data extraction and analysis across
Europe to compare medication-taking behavior at a cross-country level
bull Database networks present an opportunity for a better understanding of
medication taking behaviour and healthcare management and comparison of
healthcare policies across different settings
Methods
Databases Centre of Pharmacoeconomics and Drug utilization (CIRFF) University of Naples - Federico II Recognized as a Research Centre of Regional Relevance in Campania Region performing analysis on Regional Informative Health System (59 M inhabitants)
Aragoacuten health sciences institute (IACS) EpiChron Research Group on Chronic Diseases This group holds the EpiChron Cohort containing all relevant demographic clinical and pharmaceutical and health outcomes information of patients living in Aragoacuten (13 M inhabitants)
Royal College of Surgeons in Ireland Health Research Board (HRB) Research Leaders Award in quality and safety in medication management- Health Services Executive Primary Care Reimbursement Services (HSE-PCRS) General Medical card Scheme (GMS) pharmacy claims data (17 M people)
Flow-chart of the process in the cross-country study on medication adherence
IDENTIFICATION OF MINIMUM COMMON DATA SET
DEFINITION OF COMMON PROTOCOL ANALYSIS
SCRIPTS IMPLEMENTED AT LOCAL LEVEL
COUNTRYrsquoS INDIVIDUAL OUTCOME PARAMETER ESTIMATES
POOLING DATA IN META - ANALYSIS
How do partners collaborate in multi-database studies
Data Definition Form (DDF) describing the information contained in the data sources used in the project
Metrics Definition Form (MDF) describing all issues needing consensus among partners
Pooled estimates were obtained using a meta-analytical approach treating each country as a
different study
Drug Categories
ATC V DRUG Days of Therapy (DOTs)
M05BA04 Alendronate DDDs
M05BA06 Ibandronate DDDs
M05BA07 Risedronate DDDs
M05BB03 Alendronate + Vit D DDDs
C10AA01 simvastatin Pills
C10AA05 Atorvastatin Pills
C10AA03 Pravastatin Pills
C10AA07 Rosuvastatin Pills
C10AA02 Lovastatin Pills
A10BA Biguanides Pillsdeg
A10BB Sulfonylureas Pillsdeg
A10BF Alpha glucosidase inhibitors Pillsdeg
A10BG Thiazolidinediones Pillsdeg
A10BH Dipeptidyl peptidase 4 (DPP-4) inhibitors Pillsdeg
A10BX Other blood glucose lowering drugs excl insulins Pillsdeg
WHO Collaborating Centre for Drug Statistics Methodology Introduction to drug utilization research World Health Organization 2003 OlsquoShea MP Teeling Bennett K An observational study examining the effect of comorbidity on the rates of persistence and adherence to newly initiated oral anti‐hyperglycaemic agents Pharmacoepidemiology and drug safety 2013
Study Population
July 2010 December 2010
December 2011
FOLLOW-UP 12 months
January-June 2010
Study Population
Wash out
- Interrupters
censoring
Older people ge 65 years
First_prescription
Measuring Implementation
Implementation was quantified by the Medication Possession Ratio (MPR) a standard method1 of evaluating drug adherence defined as the number of dispensed therapy units (Defined Daily Doses) divided by the number of assumed prescription periods during the study period
100 sum(days supplied)365
1 ISPOR Medication Compliance amp Persistence Special Interest Group httpwwwispororgsigsMCP_accomplishmentsaspdefinition
The measure was dichotomized and subjects with a MPR ge 80 were classified as adherent to their treatment (lt 80 non-adherent)
Measuring Discontinuation
PERSISTENT
Index date
Index date
x Gap lt 60 days
Gap lt 60 days Gap lt 60 days Gap lt 60 days
End of the study
Drug refill Drug refill
Drug refill Drug refill Drug refill
Discontinuation date
Time to discontinuationdeg
NON PERSISTENT
Gap gt 60 days
degSwitching products within index medication classes was not considered as an interruption
Data Synthesis
bull Implementation and discontinuation rates were estimated by age and gender at the local level in each country
bull Pooled estimates using a meta-analytical approach
bull Random-effects model -anticipated heterogeneity
bull The effect of gender and age was assessed by
computing pooled odds ratios (OR) with 95 confidence intervals (95 CI)
Results
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
Proportion with poor implementation (MPRlt80) in the three European cohorts
52
61
30
Proportion discontinued treatment in the three European cohorts
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
55
60
46
Implementation discontinuation and age bull Non-adherence (MPR lt80) significantly higher for
patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 143 (95 CI 112 183) for antihyperlipidemics
ndash OR 141 (95 CI 117 170) for antiosteoporotics
ndash OR 163 (95 CI 107 247) for oral antidiabetics
bull Non-persistent (gt60 day gap) significantly higher for patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 136 (95 CI 111 168) for antihyperlipidemics
ndash OR 145 95 CI 125 170 for antiosteoporotics
ndash OR 150 95 CI 126 178 for oral antidiabetics
Limitations
bull Criteria simplified to achieve consensus among countries
bull Core data set- lack of clinical and health outcome information
bull Different population cohorts within the 3 countries
bull MPR- over estimate adherence arbitrary cut-off
Conclusion What is already known about this topic
bull Medication non-adherence is a major problem for healthcare systems
bull Pharmacy re-fill data can be used to evaluate adherence to chronic medication
What this study adds
bull Rates of non-adherence to medication vary among countries Italy had the
highest of non-adherence and Ireland had the lowest
bull It is possible to apply a harmonised method of data extraction and analysis across
Europe to compare medication-taking behavior at a cross-country level
bull Database networks present an opportunity for a better understanding of
medication taking behaviour and healthcare management and comparison of
healthcare policies across different settings
Databases Centre of Pharmacoeconomics and Drug utilization (CIRFF) University of Naples - Federico II Recognized as a Research Centre of Regional Relevance in Campania Region performing analysis on Regional Informative Health System (59 M inhabitants)
Aragoacuten health sciences institute (IACS) EpiChron Research Group on Chronic Diseases This group holds the EpiChron Cohort containing all relevant demographic clinical and pharmaceutical and health outcomes information of patients living in Aragoacuten (13 M inhabitants)
Royal College of Surgeons in Ireland Health Research Board (HRB) Research Leaders Award in quality and safety in medication management- Health Services Executive Primary Care Reimbursement Services (HSE-PCRS) General Medical card Scheme (GMS) pharmacy claims data (17 M people)
Flow-chart of the process in the cross-country study on medication adherence
IDENTIFICATION OF MINIMUM COMMON DATA SET
DEFINITION OF COMMON PROTOCOL ANALYSIS
SCRIPTS IMPLEMENTED AT LOCAL LEVEL
COUNTRYrsquoS INDIVIDUAL OUTCOME PARAMETER ESTIMATES
POOLING DATA IN META - ANALYSIS
How do partners collaborate in multi-database studies
Data Definition Form (DDF) describing the information contained in the data sources used in the project
Metrics Definition Form (MDF) describing all issues needing consensus among partners
Pooled estimates were obtained using a meta-analytical approach treating each country as a
different study
Drug Categories
ATC V DRUG Days of Therapy (DOTs)
M05BA04 Alendronate DDDs
M05BA06 Ibandronate DDDs
M05BA07 Risedronate DDDs
M05BB03 Alendronate + Vit D DDDs
C10AA01 simvastatin Pills
C10AA05 Atorvastatin Pills
C10AA03 Pravastatin Pills
C10AA07 Rosuvastatin Pills
C10AA02 Lovastatin Pills
A10BA Biguanides Pillsdeg
A10BB Sulfonylureas Pillsdeg
A10BF Alpha glucosidase inhibitors Pillsdeg
A10BG Thiazolidinediones Pillsdeg
A10BH Dipeptidyl peptidase 4 (DPP-4) inhibitors Pillsdeg
A10BX Other blood glucose lowering drugs excl insulins Pillsdeg
WHO Collaborating Centre for Drug Statistics Methodology Introduction to drug utilization research World Health Organization 2003 OlsquoShea MP Teeling Bennett K An observational study examining the effect of comorbidity on the rates of persistence and adherence to newly initiated oral anti‐hyperglycaemic agents Pharmacoepidemiology and drug safety 2013
Study Population
July 2010 December 2010
December 2011
FOLLOW-UP 12 months
January-June 2010
Study Population
Wash out
- Interrupters
censoring
Older people ge 65 years
First_prescription
Measuring Implementation
Implementation was quantified by the Medication Possession Ratio (MPR) a standard method1 of evaluating drug adherence defined as the number of dispensed therapy units (Defined Daily Doses) divided by the number of assumed prescription periods during the study period
100 sum(days supplied)365
1 ISPOR Medication Compliance amp Persistence Special Interest Group httpwwwispororgsigsMCP_accomplishmentsaspdefinition
The measure was dichotomized and subjects with a MPR ge 80 were classified as adherent to their treatment (lt 80 non-adherent)
Measuring Discontinuation
PERSISTENT
Index date
Index date
x Gap lt 60 days
Gap lt 60 days Gap lt 60 days Gap lt 60 days
End of the study
Drug refill Drug refill
Drug refill Drug refill Drug refill
Discontinuation date
Time to discontinuationdeg
NON PERSISTENT
Gap gt 60 days
degSwitching products within index medication classes was not considered as an interruption
Data Synthesis
bull Implementation and discontinuation rates were estimated by age and gender at the local level in each country
bull Pooled estimates using a meta-analytical approach
bull Random-effects model -anticipated heterogeneity
bull The effect of gender and age was assessed by
computing pooled odds ratios (OR) with 95 confidence intervals (95 CI)
Results
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
Proportion with poor implementation (MPRlt80) in the three European cohorts
52
61
30
Proportion discontinued treatment in the three European cohorts
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
55
60
46
Implementation discontinuation and age bull Non-adherence (MPR lt80) significantly higher for
patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 143 (95 CI 112 183) for antihyperlipidemics
ndash OR 141 (95 CI 117 170) for antiosteoporotics
ndash OR 163 (95 CI 107 247) for oral antidiabetics
bull Non-persistent (gt60 day gap) significantly higher for patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 136 (95 CI 111 168) for antihyperlipidemics
ndash OR 145 95 CI 125 170 for antiosteoporotics
ndash OR 150 95 CI 126 178 for oral antidiabetics
Limitations
bull Criteria simplified to achieve consensus among countries
bull Core data set- lack of clinical and health outcome information
bull Different population cohorts within the 3 countries
bull MPR- over estimate adherence arbitrary cut-off
Conclusion What is already known about this topic
bull Medication non-adherence is a major problem for healthcare systems
bull Pharmacy re-fill data can be used to evaluate adherence to chronic medication
What this study adds
bull Rates of non-adherence to medication vary among countries Italy had the
highest of non-adherence and Ireland had the lowest
bull It is possible to apply a harmonised method of data extraction and analysis across
Europe to compare medication-taking behavior at a cross-country level
bull Database networks present an opportunity for a better understanding of
medication taking behaviour and healthcare management and comparison of
healthcare policies across different settings
Flow-chart of the process in the cross-country study on medication adherence
IDENTIFICATION OF MINIMUM COMMON DATA SET
DEFINITION OF COMMON PROTOCOL ANALYSIS
SCRIPTS IMPLEMENTED AT LOCAL LEVEL
COUNTRYrsquoS INDIVIDUAL OUTCOME PARAMETER ESTIMATES
POOLING DATA IN META - ANALYSIS
How do partners collaborate in multi-database studies
Data Definition Form (DDF) describing the information contained in the data sources used in the project
Metrics Definition Form (MDF) describing all issues needing consensus among partners
Pooled estimates were obtained using a meta-analytical approach treating each country as a
different study
Drug Categories
ATC V DRUG Days of Therapy (DOTs)
M05BA04 Alendronate DDDs
M05BA06 Ibandronate DDDs
M05BA07 Risedronate DDDs
M05BB03 Alendronate + Vit D DDDs
C10AA01 simvastatin Pills
C10AA05 Atorvastatin Pills
C10AA03 Pravastatin Pills
C10AA07 Rosuvastatin Pills
C10AA02 Lovastatin Pills
A10BA Biguanides Pillsdeg
A10BB Sulfonylureas Pillsdeg
A10BF Alpha glucosidase inhibitors Pillsdeg
A10BG Thiazolidinediones Pillsdeg
A10BH Dipeptidyl peptidase 4 (DPP-4) inhibitors Pillsdeg
A10BX Other blood glucose lowering drugs excl insulins Pillsdeg
WHO Collaborating Centre for Drug Statistics Methodology Introduction to drug utilization research World Health Organization 2003 OlsquoShea MP Teeling Bennett K An observational study examining the effect of comorbidity on the rates of persistence and adherence to newly initiated oral anti‐hyperglycaemic agents Pharmacoepidemiology and drug safety 2013
Study Population
July 2010 December 2010
December 2011
FOLLOW-UP 12 months
January-June 2010
Study Population
Wash out
- Interrupters
censoring
Older people ge 65 years
First_prescription
Measuring Implementation
Implementation was quantified by the Medication Possession Ratio (MPR) a standard method1 of evaluating drug adherence defined as the number of dispensed therapy units (Defined Daily Doses) divided by the number of assumed prescription periods during the study period
100 sum(days supplied)365
1 ISPOR Medication Compliance amp Persistence Special Interest Group httpwwwispororgsigsMCP_accomplishmentsaspdefinition
The measure was dichotomized and subjects with a MPR ge 80 were classified as adherent to their treatment (lt 80 non-adherent)
Measuring Discontinuation
PERSISTENT
Index date
Index date
x Gap lt 60 days
Gap lt 60 days Gap lt 60 days Gap lt 60 days
End of the study
Drug refill Drug refill
Drug refill Drug refill Drug refill
Discontinuation date
Time to discontinuationdeg
NON PERSISTENT
Gap gt 60 days
degSwitching products within index medication classes was not considered as an interruption
Data Synthesis
bull Implementation and discontinuation rates were estimated by age and gender at the local level in each country
bull Pooled estimates using a meta-analytical approach
bull Random-effects model -anticipated heterogeneity
bull The effect of gender and age was assessed by
computing pooled odds ratios (OR) with 95 confidence intervals (95 CI)
Results
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
Proportion with poor implementation (MPRlt80) in the three European cohorts
52
61
30
Proportion discontinued treatment in the three European cohorts
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
55
60
46
Implementation discontinuation and age bull Non-adherence (MPR lt80) significantly higher for
patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 143 (95 CI 112 183) for antihyperlipidemics
ndash OR 141 (95 CI 117 170) for antiosteoporotics
ndash OR 163 (95 CI 107 247) for oral antidiabetics
bull Non-persistent (gt60 day gap) significantly higher for patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 136 (95 CI 111 168) for antihyperlipidemics
ndash OR 145 95 CI 125 170 for antiosteoporotics
ndash OR 150 95 CI 126 178 for oral antidiabetics
Limitations
bull Criteria simplified to achieve consensus among countries
bull Core data set- lack of clinical and health outcome information
bull Different population cohorts within the 3 countries
bull MPR- over estimate adherence arbitrary cut-off
Conclusion What is already known about this topic
bull Medication non-adherence is a major problem for healthcare systems
bull Pharmacy re-fill data can be used to evaluate adherence to chronic medication
What this study adds
bull Rates of non-adherence to medication vary among countries Italy had the
highest of non-adherence and Ireland had the lowest
bull It is possible to apply a harmonised method of data extraction and analysis across
Europe to compare medication-taking behavior at a cross-country level
bull Database networks present an opportunity for a better understanding of
medication taking behaviour and healthcare management and comparison of
healthcare policies across different settings
Drug Categories
ATC V DRUG Days of Therapy (DOTs)
M05BA04 Alendronate DDDs
M05BA06 Ibandronate DDDs
M05BA07 Risedronate DDDs
M05BB03 Alendronate + Vit D DDDs
C10AA01 simvastatin Pills
C10AA05 Atorvastatin Pills
C10AA03 Pravastatin Pills
C10AA07 Rosuvastatin Pills
C10AA02 Lovastatin Pills
A10BA Biguanides Pillsdeg
A10BB Sulfonylureas Pillsdeg
A10BF Alpha glucosidase inhibitors Pillsdeg
A10BG Thiazolidinediones Pillsdeg
A10BH Dipeptidyl peptidase 4 (DPP-4) inhibitors Pillsdeg
A10BX Other blood glucose lowering drugs excl insulins Pillsdeg
WHO Collaborating Centre for Drug Statistics Methodology Introduction to drug utilization research World Health Organization 2003 OlsquoShea MP Teeling Bennett K An observational study examining the effect of comorbidity on the rates of persistence and adherence to newly initiated oral anti‐hyperglycaemic agents Pharmacoepidemiology and drug safety 2013
Study Population
July 2010 December 2010
December 2011
FOLLOW-UP 12 months
January-June 2010
Study Population
Wash out
- Interrupters
censoring
Older people ge 65 years
First_prescription
Measuring Implementation
Implementation was quantified by the Medication Possession Ratio (MPR) a standard method1 of evaluating drug adherence defined as the number of dispensed therapy units (Defined Daily Doses) divided by the number of assumed prescription periods during the study period
100 sum(days supplied)365
1 ISPOR Medication Compliance amp Persistence Special Interest Group httpwwwispororgsigsMCP_accomplishmentsaspdefinition
The measure was dichotomized and subjects with a MPR ge 80 were classified as adherent to their treatment (lt 80 non-adherent)
Measuring Discontinuation
PERSISTENT
Index date
Index date
x Gap lt 60 days
Gap lt 60 days Gap lt 60 days Gap lt 60 days
End of the study
Drug refill Drug refill
Drug refill Drug refill Drug refill
Discontinuation date
Time to discontinuationdeg
NON PERSISTENT
Gap gt 60 days
degSwitching products within index medication classes was not considered as an interruption
Data Synthesis
bull Implementation and discontinuation rates were estimated by age and gender at the local level in each country
bull Pooled estimates using a meta-analytical approach
bull Random-effects model -anticipated heterogeneity
bull The effect of gender and age was assessed by
computing pooled odds ratios (OR) with 95 confidence intervals (95 CI)
Results
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
Proportion with poor implementation (MPRlt80) in the three European cohorts
52
61
30
Proportion discontinued treatment in the three European cohorts
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
55
60
46
Implementation discontinuation and age bull Non-adherence (MPR lt80) significantly higher for
patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 143 (95 CI 112 183) for antihyperlipidemics
ndash OR 141 (95 CI 117 170) for antiosteoporotics
ndash OR 163 (95 CI 107 247) for oral antidiabetics
bull Non-persistent (gt60 day gap) significantly higher for patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 136 (95 CI 111 168) for antihyperlipidemics
ndash OR 145 95 CI 125 170 for antiosteoporotics
ndash OR 150 95 CI 126 178 for oral antidiabetics
Limitations
bull Criteria simplified to achieve consensus among countries
bull Core data set- lack of clinical and health outcome information
bull Different population cohorts within the 3 countries
bull MPR- over estimate adherence arbitrary cut-off
Conclusion What is already known about this topic
bull Medication non-adherence is a major problem for healthcare systems
bull Pharmacy re-fill data can be used to evaluate adherence to chronic medication
What this study adds
bull Rates of non-adherence to medication vary among countries Italy had the
highest of non-adherence and Ireland had the lowest
bull It is possible to apply a harmonised method of data extraction and analysis across
Europe to compare medication-taking behavior at a cross-country level
bull Database networks present an opportunity for a better understanding of
medication taking behaviour and healthcare management and comparison of
healthcare policies across different settings
Study Population
July 2010 December 2010
December 2011
FOLLOW-UP 12 months
January-June 2010
Study Population
Wash out
- Interrupters
censoring
Older people ge 65 years
First_prescription
Measuring Implementation
Implementation was quantified by the Medication Possession Ratio (MPR) a standard method1 of evaluating drug adherence defined as the number of dispensed therapy units (Defined Daily Doses) divided by the number of assumed prescription periods during the study period
100 sum(days supplied)365
1 ISPOR Medication Compliance amp Persistence Special Interest Group httpwwwispororgsigsMCP_accomplishmentsaspdefinition
The measure was dichotomized and subjects with a MPR ge 80 were classified as adherent to their treatment (lt 80 non-adherent)
Measuring Discontinuation
PERSISTENT
Index date
Index date
x Gap lt 60 days
Gap lt 60 days Gap lt 60 days Gap lt 60 days
End of the study
Drug refill Drug refill
Drug refill Drug refill Drug refill
Discontinuation date
Time to discontinuationdeg
NON PERSISTENT
Gap gt 60 days
degSwitching products within index medication classes was not considered as an interruption
Data Synthesis
bull Implementation and discontinuation rates were estimated by age and gender at the local level in each country
bull Pooled estimates using a meta-analytical approach
bull Random-effects model -anticipated heterogeneity
bull The effect of gender and age was assessed by
computing pooled odds ratios (OR) with 95 confidence intervals (95 CI)
Results
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
Proportion with poor implementation (MPRlt80) in the three European cohorts
52
61
30
Proportion discontinued treatment in the three European cohorts
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
55
60
46
Implementation discontinuation and age bull Non-adherence (MPR lt80) significantly higher for
patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 143 (95 CI 112 183) for antihyperlipidemics
ndash OR 141 (95 CI 117 170) for antiosteoporotics
ndash OR 163 (95 CI 107 247) for oral antidiabetics
bull Non-persistent (gt60 day gap) significantly higher for patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 136 (95 CI 111 168) for antihyperlipidemics
ndash OR 145 95 CI 125 170 for antiosteoporotics
ndash OR 150 95 CI 126 178 for oral antidiabetics
Limitations
bull Criteria simplified to achieve consensus among countries
bull Core data set- lack of clinical and health outcome information
bull Different population cohorts within the 3 countries
bull MPR- over estimate adherence arbitrary cut-off
Conclusion What is already known about this topic
bull Medication non-adherence is a major problem for healthcare systems
bull Pharmacy re-fill data can be used to evaluate adherence to chronic medication
What this study adds
bull Rates of non-adherence to medication vary among countries Italy had the
highest of non-adherence and Ireland had the lowest
bull It is possible to apply a harmonised method of data extraction and analysis across
Europe to compare medication-taking behavior at a cross-country level
bull Database networks present an opportunity for a better understanding of
medication taking behaviour and healthcare management and comparison of
healthcare policies across different settings
Measuring Implementation
Implementation was quantified by the Medication Possession Ratio (MPR) a standard method1 of evaluating drug adherence defined as the number of dispensed therapy units (Defined Daily Doses) divided by the number of assumed prescription periods during the study period
100 sum(days supplied)365
1 ISPOR Medication Compliance amp Persistence Special Interest Group httpwwwispororgsigsMCP_accomplishmentsaspdefinition
The measure was dichotomized and subjects with a MPR ge 80 were classified as adherent to their treatment (lt 80 non-adherent)
Measuring Discontinuation
PERSISTENT
Index date
Index date
x Gap lt 60 days
Gap lt 60 days Gap lt 60 days Gap lt 60 days
End of the study
Drug refill Drug refill
Drug refill Drug refill Drug refill
Discontinuation date
Time to discontinuationdeg
NON PERSISTENT
Gap gt 60 days
degSwitching products within index medication classes was not considered as an interruption
Data Synthesis
bull Implementation and discontinuation rates were estimated by age and gender at the local level in each country
bull Pooled estimates using a meta-analytical approach
bull Random-effects model -anticipated heterogeneity
bull The effect of gender and age was assessed by
computing pooled odds ratios (OR) with 95 confidence intervals (95 CI)
Results
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
Proportion with poor implementation (MPRlt80) in the three European cohorts
52
61
30
Proportion discontinued treatment in the three European cohorts
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
55
60
46
Implementation discontinuation and age bull Non-adherence (MPR lt80) significantly higher for
patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 143 (95 CI 112 183) for antihyperlipidemics
ndash OR 141 (95 CI 117 170) for antiosteoporotics
ndash OR 163 (95 CI 107 247) for oral antidiabetics
bull Non-persistent (gt60 day gap) significantly higher for patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 136 (95 CI 111 168) for antihyperlipidemics
ndash OR 145 95 CI 125 170 for antiosteoporotics
ndash OR 150 95 CI 126 178 for oral antidiabetics
Limitations
bull Criteria simplified to achieve consensus among countries
bull Core data set- lack of clinical and health outcome information
bull Different population cohorts within the 3 countries
bull MPR- over estimate adherence arbitrary cut-off
Conclusion What is already known about this topic
bull Medication non-adherence is a major problem for healthcare systems
bull Pharmacy re-fill data can be used to evaluate adherence to chronic medication
What this study adds
bull Rates of non-adherence to medication vary among countries Italy had the
highest of non-adherence and Ireland had the lowest
bull It is possible to apply a harmonised method of data extraction and analysis across
Europe to compare medication-taking behavior at a cross-country level
bull Database networks present an opportunity for a better understanding of
medication taking behaviour and healthcare management and comparison of
healthcare policies across different settings
Measuring Discontinuation
PERSISTENT
Index date
Index date
x Gap lt 60 days
Gap lt 60 days Gap lt 60 days Gap lt 60 days
End of the study
Drug refill Drug refill
Drug refill Drug refill Drug refill
Discontinuation date
Time to discontinuationdeg
NON PERSISTENT
Gap gt 60 days
degSwitching products within index medication classes was not considered as an interruption
Data Synthesis
bull Implementation and discontinuation rates were estimated by age and gender at the local level in each country
bull Pooled estimates using a meta-analytical approach
bull Random-effects model -anticipated heterogeneity
bull The effect of gender and age was assessed by
computing pooled odds ratios (OR) with 95 confidence intervals (95 CI)
Results
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
Proportion with poor implementation (MPRlt80) in the three European cohorts
52
61
30
Proportion discontinued treatment in the three European cohorts
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
55
60
46
Implementation discontinuation and age bull Non-adherence (MPR lt80) significantly higher for
patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 143 (95 CI 112 183) for antihyperlipidemics
ndash OR 141 (95 CI 117 170) for antiosteoporotics
ndash OR 163 (95 CI 107 247) for oral antidiabetics
bull Non-persistent (gt60 day gap) significantly higher for patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 136 (95 CI 111 168) for antihyperlipidemics
ndash OR 145 95 CI 125 170 for antiosteoporotics
ndash OR 150 95 CI 126 178 for oral antidiabetics
Limitations
bull Criteria simplified to achieve consensus among countries
bull Core data set- lack of clinical and health outcome information
bull Different population cohorts within the 3 countries
bull MPR- over estimate adherence arbitrary cut-off
Conclusion What is already known about this topic
bull Medication non-adherence is a major problem for healthcare systems
bull Pharmacy re-fill data can be used to evaluate adherence to chronic medication
What this study adds
bull Rates of non-adherence to medication vary among countries Italy had the
highest of non-adherence and Ireland had the lowest
bull It is possible to apply a harmonised method of data extraction and analysis across
Europe to compare medication-taking behavior at a cross-country level
bull Database networks present an opportunity for a better understanding of
medication taking behaviour and healthcare management and comparison of
healthcare policies across different settings
Data Synthesis
bull Implementation and discontinuation rates were estimated by age and gender at the local level in each country
bull Pooled estimates using a meta-analytical approach
bull Random-effects model -anticipated heterogeneity
bull The effect of gender and age was assessed by
computing pooled odds ratios (OR) with 95 confidence intervals (95 CI)
Results
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
Proportion with poor implementation (MPRlt80) in the three European cohorts
52
61
30
Proportion discontinued treatment in the three European cohorts
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
55
60
46
Implementation discontinuation and age bull Non-adherence (MPR lt80) significantly higher for
patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 143 (95 CI 112 183) for antihyperlipidemics
ndash OR 141 (95 CI 117 170) for antiosteoporotics
ndash OR 163 (95 CI 107 247) for oral antidiabetics
bull Non-persistent (gt60 day gap) significantly higher for patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 136 (95 CI 111 168) for antihyperlipidemics
ndash OR 145 95 CI 125 170 for antiosteoporotics
ndash OR 150 95 CI 126 178 for oral antidiabetics
Limitations
bull Criteria simplified to achieve consensus among countries
bull Core data set- lack of clinical and health outcome information
bull Different population cohorts within the 3 countries
bull MPR- over estimate adherence arbitrary cut-off
Conclusion What is already known about this topic
bull Medication non-adherence is a major problem for healthcare systems
bull Pharmacy re-fill data can be used to evaluate adherence to chronic medication
What this study adds
bull Rates of non-adherence to medication vary among countries Italy had the
highest of non-adherence and Ireland had the lowest
bull It is possible to apply a harmonised method of data extraction and analysis across
Europe to compare medication-taking behavior at a cross-country level
bull Database networks present an opportunity for a better understanding of
medication taking behaviour and healthcare management and comparison of
healthcare policies across different settings
Results
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
Proportion with poor implementation (MPRlt80) in the three European cohorts
52
61
30
Proportion discontinued treatment in the three European cohorts
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
55
60
46
Implementation discontinuation and age bull Non-adherence (MPR lt80) significantly higher for
patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 143 (95 CI 112 183) for antihyperlipidemics
ndash OR 141 (95 CI 117 170) for antiosteoporotics
ndash OR 163 (95 CI 107 247) for oral antidiabetics
bull Non-persistent (gt60 day gap) significantly higher for patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 136 (95 CI 111 168) for antihyperlipidemics
ndash OR 145 95 CI 125 170 for antiosteoporotics
ndash OR 150 95 CI 126 178 for oral antidiabetics
Limitations
bull Criteria simplified to achieve consensus among countries
bull Core data set- lack of clinical and health outcome information
bull Different population cohorts within the 3 countries
bull MPR- over estimate adherence arbitrary cut-off
Conclusion What is already known about this topic
bull Medication non-adherence is a major problem for healthcare systems
bull Pharmacy re-fill data can be used to evaluate adherence to chronic medication
What this study adds
bull Rates of non-adherence to medication vary among countries Italy had the
highest of non-adherence and Ireland had the lowest
bull It is possible to apply a harmonised method of data extraction and analysis across
Europe to compare medication-taking behavior at a cross-country level
bull Database networks present an opportunity for a better understanding of
medication taking behaviour and healthcare management and comparison of
healthcare policies across different settings
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
Proportion with poor implementation (MPRlt80) in the three European cohorts
52
61
30
Proportion discontinued treatment in the three European cohorts
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
55
60
46
Implementation discontinuation and age bull Non-adherence (MPR lt80) significantly higher for
patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 143 (95 CI 112 183) for antihyperlipidemics
ndash OR 141 (95 CI 117 170) for antiosteoporotics
ndash OR 163 (95 CI 107 247) for oral antidiabetics
bull Non-persistent (gt60 day gap) significantly higher for patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 136 (95 CI 111 168) for antihyperlipidemics
ndash OR 145 95 CI 125 170 for antiosteoporotics
ndash OR 150 95 CI 126 178 for oral antidiabetics
Limitations
bull Criteria simplified to achieve consensus among countries
bull Core data set- lack of clinical and health outcome information
bull Different population cohorts within the 3 countries
bull MPR- over estimate adherence arbitrary cut-off
Conclusion What is already known about this topic
bull Medication non-adherence is a major problem for healthcare systems
bull Pharmacy re-fill data can be used to evaluate adherence to chronic medication
What this study adds
bull Rates of non-adherence to medication vary among countries Italy had the
highest of non-adherence and Ireland had the lowest
bull It is possible to apply a harmonised method of data extraction and analysis across
Europe to compare medication-taking behavior at a cross-country level
bull Database networks present an opportunity for a better understanding of
medication taking behaviour and healthcare management and comparison of
healthcare policies across different settings
Proportion discontinued treatment in the three European cohorts
Hyperlipidemics
Oral hypoglicemics
Bisphosphonates
55
60
46
Implementation discontinuation and age bull Non-adherence (MPR lt80) significantly higher for
patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 143 (95 CI 112 183) for antihyperlipidemics
ndash OR 141 (95 CI 117 170) for antiosteoporotics
ndash OR 163 (95 CI 107 247) for oral antidiabetics
bull Non-persistent (gt60 day gap) significantly higher for patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 136 (95 CI 111 168) for antihyperlipidemics
ndash OR 145 95 CI 125 170 for antiosteoporotics
ndash OR 150 95 CI 126 178 for oral antidiabetics
Limitations
bull Criteria simplified to achieve consensus among countries
bull Core data set- lack of clinical and health outcome information
bull Different population cohorts within the 3 countries
bull MPR- over estimate adherence arbitrary cut-off
Conclusion What is already known about this topic
bull Medication non-adherence is a major problem for healthcare systems
bull Pharmacy re-fill data can be used to evaluate adherence to chronic medication
What this study adds
bull Rates of non-adherence to medication vary among countries Italy had the
highest of non-adherence and Ireland had the lowest
bull It is possible to apply a harmonised method of data extraction and analysis across
Europe to compare medication-taking behavior at a cross-country level
bull Database networks present an opportunity for a better understanding of
medication taking behaviour and healthcare management and comparison of
healthcare policies across different settings
Implementation discontinuation and age bull Non-adherence (MPR lt80) significantly higher for
patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 143 (95 CI 112 183) for antihyperlipidemics
ndash OR 141 (95 CI 117 170) for antiosteoporotics
ndash OR 163 (95 CI 107 247) for oral antidiabetics
bull Non-persistent (gt60 day gap) significantly higher for patients aged ge85 years compared to patients aged 65ndash74 years
ndash OR 136 (95 CI 111 168) for antihyperlipidemics
ndash OR 145 95 CI 125 170 for antiosteoporotics
ndash OR 150 95 CI 126 178 for oral antidiabetics
Limitations
bull Criteria simplified to achieve consensus among countries
bull Core data set- lack of clinical and health outcome information
bull Different population cohorts within the 3 countries
bull MPR- over estimate adherence arbitrary cut-off
Conclusion What is already known about this topic
bull Medication non-adherence is a major problem for healthcare systems
bull Pharmacy re-fill data can be used to evaluate adherence to chronic medication
What this study adds
bull Rates of non-adherence to medication vary among countries Italy had the
highest of non-adherence and Ireland had the lowest
bull It is possible to apply a harmonised method of data extraction and analysis across
Europe to compare medication-taking behavior at a cross-country level
bull Database networks present an opportunity for a better understanding of
medication taking behaviour and healthcare management and comparison of
healthcare policies across different settings
Limitations
bull Criteria simplified to achieve consensus among countries
bull Core data set- lack of clinical and health outcome information
bull Different population cohorts within the 3 countries
bull MPR- over estimate adherence arbitrary cut-off
Conclusion What is already known about this topic
bull Medication non-adherence is a major problem for healthcare systems
bull Pharmacy re-fill data can be used to evaluate adherence to chronic medication
What this study adds
bull Rates of non-adherence to medication vary among countries Italy had the
highest of non-adherence and Ireland had the lowest
bull It is possible to apply a harmonised method of data extraction and analysis across
Europe to compare medication-taking behavior at a cross-country level
bull Database networks present an opportunity for a better understanding of
medication taking behaviour and healthcare management and comparison of
healthcare policies across different settings
Conclusion What is already known about this topic
bull Medication non-adherence is a major problem for healthcare systems
bull Pharmacy re-fill data can be used to evaluate adherence to chronic medication
What this study adds
bull Rates of non-adherence to medication vary among countries Italy had the
highest of non-adherence and Ireland had the lowest
bull It is possible to apply a harmonised method of data extraction and analysis across
Europe to compare medication-taking behavior at a cross-country level
bull Database networks present an opportunity for a better understanding of
medication taking behaviour and healthcare management and comparison of
healthcare policies across different settings
