Patient Preference and Adherence (May 2018)
Adherence rates and health care costs in Crohn's disease patients receiving certolizumab pegol with and without home health nurse assistance: results from a retrospective analysis of patient claims and home health nurse data
Abstract
Douglas C Wolf,1 Srihari Jaganathan,2 Chakkarin Burudpakdee,3 Arpamas Seetasith,3 Robert Low,2 Edward Lee,4 Jay Gucky,2 Mohamed Yassine,4 David A Schwartz5 1Atlanta Gastroenterology Associates, Atlanta, GA, 2UCB Pharma, Smyrna, GA, 3IQVIA, Fairfax, VA, 4UCB Pharma, Atlanta, GA, 5Inflammatory Bowel Disease Center, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN, USA Background: Patient support programs have a positive effect on adherence to therapy. Certolizumab pegol (CZP) is a tumor necrosis factor antagonist for the treatment of Crohn’s disease. Objectives: To assess, using real-world claims data, whether home health nurse assistance had an effect on patients’ adherence to CZP and to measure its impact on health care use and costs. Methods: A retrospective analysis of medical and pharmacy claims data from the IQVIA Real-World Data Adjudicated Claims Database was conducted using data from January 1, 2007 through September 30, 2015. CZP patients with Crohn’s disease were eligible to receive self-administration instructions from a nurse or nurse-administered CZP injections, or both. These services were provided by CIMplicity®, a home health nurse program sponsored by UCB Pharma. Cohorts were based on patients with and without nurse assistance and were matched based on gender and categorical age. Adherence to CZP was determined using the medication possession ratio (MPR) and proportion of days covered (PDC). A Kaplan–Meier analysis was performed to compare time to discontinuation of CZP between the two cohorts. Multivariate regression analyses were performed, adjusting for additional covariates to compare the effect of CZP with and without nurse assistance on hospitalization and total health care costs. Results: Patients with at least 12 months of continuous enrollment post-index date were evaluated for adherence to CZP (n=276 in each cohort). The mean and median PDC and MPR values were higher with nurse assistance than without. Time to discontinuation was significantly longer in patients who received CZP with nurse assistance than without (P=0.0004). Results from the multivariate analyses showed a significant reduction in all-cause hospitalization (-55.8%; P=0.0026) and total health care costs (-14.3%; P=0.0045) with nurse assistance. Conclusion: This analysis suggests that home health nurse assistance increases adherence to CZP and reduces health care costs in patients with Crohn’s disease. Keywords: certolizumab pegol, adherence, cost, nurse assistance, patient support program, Crohn’s disease, claims data
