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首页> 外文期刊>Patient Preference and Adherence >Impact of adherence to biological agents on health care resource utilization for patients over the age of 65 years with rheumatoid arthritis
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Impact of adherence to biological agents on health care resource utilization for patients over the age of 65 years with rheumatoid arthritis

机译：坚持使用生物制剂对65岁以上类风湿关节炎患者的卫生保健资源利用的影响

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Objective: Poor adherence to therapy increases the patient and societal burden and complexity of chronic diseases such as rheumatoid arthritis (RA). In the past 15?years, biologic disease-modifying anti-rheumatic drugs (DMARDs) have revolutionized the treatment of RA. However, little data are available on the impact of adherence to biologics on health care resources. The objective of the study was to determine the long-term health care resource utilization patterns of RA patients who were adherent to biologic DMARD therapy compared to RA patients who were non-adherent to biologic DMARD therapy in an Ontario population and to determine factors influencing adherence. Methods: Patients were identified from the Ontario RA Database that contains all RA patients in Ontario, Canada, identified since 1991. The study population included RA patients, aged 65+?years, with a prescription for a biologic DMARD between 2003 and 2013. Exclusion criteria included diagnosis of inflammatory bowel disease, psoriatic arthritis or psoriasis in the 5?years prior to the index date and discontinuation of biologic DMARD, defined as no subsequent prescription during the 12?months after the index date. Adherence was defined as a medication possession ratio of ≥0.8 measured as the proportion of days for which a patient had biologic treatment(s) over a defined follow-up period. Adherent patients were matched to non-adherent patients by propensity score matching. Results: A total of 4,666 RA patients were identified, of whom 2,749 were deemed adherent and 1,917 non-adherent. The age (standard deviation) was 69.9 (5.46)?years and 75% were female. Relative rates for resource use (physician visits, emergency visits, hospitalization, home care and rehabilitation) for the matched cohort were significantly lower ( P <0.0001) in adherent patients. Non-adherent patients’ use of oral prednisone (67%) was significantly higher ( P <0.001) than that of the adherent cohort (56%). Conclusion: RA patients adherent to biologic therapy have lower health care resource use and lower steroid use compared to non-adherent patients.
机译：目的：对治疗的依从性差会增加患者和社会的负担，并增加诸如类风湿关节炎（RA）等慢性疾病的复杂性。在过去的15年中，改变生物疾病的抗风湿药（DMARD）彻底改变了RA的治疗方法。但是，很少有数据表明遵守生物制剂对卫生保健资源的影响。这项研究的目的是确定在安大略省人群中，坚持生物DMARD治疗的RA患者与不坚持生物DMARD治疗的RA患者的长期医疗保健资源利用方式，并确定影响依从性的因素。方法：从安大略省RA数据库中识别患者，该数据库包含自1991年以来加拿大安大略省的所有RA患者。研究人群包括65岁及65岁以上的RA患者，并在2003年至2013年之间开具了生物DMARD处方。标准包括在索引日期之前5年内诊断出炎症性肠病，牛皮癣性关节炎或牛皮癣，并终止生物DMARD，这被定义为在索引日期之后12个月内没有后续处方。依从性被定义为≥0.8的药物占有率，该比率是指患者在规定的随访期内接受生物治疗的天数。通过倾向评分匹配将依从患者与未依从患者进行匹配。结果：共鉴定出4,666例RA患者，其中2,749例为依从性，1,917例为非依从性。年龄（标准差）为69.9（5.46）？岁，女性为75％。在依从性患者中，匹配队列的资源使用相对比率（内科医生就诊，急诊就诊，住院，家庭护理和康复）相对较低（P <0.0001）。非依从性患者口服泼尼松的使用率（67％）显着高于依从性队列（56％）（P <0.001）。结论：与非依从性患者相比，坚持生物疗法的RA患者的医疗保健资源使用量和类固醇的使用率较低。

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