Adherence to dornase alfa treatment among commercially insured patients with cystic fibrosis
Open accessAbstract
OBJECTIVE: To investigate adherence to dornase alfa therapy among commercially-insured patients with cystic fibrosis (CF) and to examine the impact of adherence on health and economic outcomes. METHODS: This retrospective cohort analysis included CF patients with ≥1 dornase alfa (Pulmozyme) pharmacy claim between 1 October 2006 and 30 September 2008 and with continuous enrollment in the health insurance plan at least 1 year before and 1 year after their index dornase alfa claim. Adherence was measured with the medication possession ratio (MPR). Multivariate models were used to estimate the relationship between adherence and exacerbations, utilization, and cost. RESULTS: Nine hundred and seven patients met the inclusion criteria. The mean age was 19.5 years (SD = 11.5) and 49.1% were female. Overall MPR was 0.59 and by age was 0.66 for patients of 5-12 years, 0.57 for 13-20 years, 0.54 for 21-30 years, and 0.56 for patients ≥31 years. Adherence was better in fall and winter than in spring and summer. There was no statistically significant difference in the proportion of patients with inpatient respiratory exacerbations across groups with low (<0.5), moderate (0.5-0.79), and high (≥0.8) adherence (24.5%, 22.3%, and 19.1%, respectively, p = 0.250). There was a trend toward higher total charges in more-adherent patients (mean $58,612 in the least-adherent group and mean $69,427 in the most adherent group, p = 0.107). In multivariate models, MPR was not significantly associated with the risk of inpatient respiratory exacerbations (hazard ratio = 1.16 for MPR <0.5 vs ≥0.8; 95% CI = 0.83-1.61). LIMITATIONS: Study data were derived from insurance claims; adherence measures were based on prescription fills, not observed medication use. CONCLUSION: Adherence to dornase alfa was generally low, but varied by age and season. Adherence was not found to be significantly associated with respiratory exacerbations or total charges, but was associated with shorter hospital length of stay.
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Higher adherence to dornase alfa is associated with a shorter length of hospital stay.
“Two trials have demonstrated the importance of adherence to inhaled therapies on health outcomes, with higher adherence to dornase alfa being associated with a shorter length of hospital stay (Nasr 2013);”
From Psychological interventions for improving adherence to inhaled therapies in people with cystic fibrosis (2023) · cites this paper as Nasr 2013
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- Authors
- Nasr, S. Z., Chou, W., Villa, K. F., Chang, E., & Broder, M. S.
- Affiliations
- Michigan Medicine (US)
- Genentech (US)
- Partnership for Health Analytic Research (US)
- Corresponding author
- Villa, Kathleen F.
- Venue
- Journal of Medical Economics
- Publisher
- Informa Healthcare
- Published
- 2013-04-04
- Volume
- 16
- Issue
- 6
- Pages
- 801-808
- ISSN
- 1369-6998 (ISSN-L)
- 1941-837X
- OpenAlex
- W2030810985
- Cited by
- 44
- References
- 16
- Citations by year
- 2026: 1 · 2025: 2 · 2023: 5 · 2022: 3 · 2021: 3 · 2020: 3 · 2019: 4 · 2018: 6 · 2017: 4 · 2016: 2 · 2015: 3 · 2014: 7 · 2013: 1
- FWCI
- 3.52
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Medical Economics (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Genentech
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cystic Fibrosis Research Advances
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Inhalation and Respiratory Drug Delivery
- Keywords
- dornase alfa, Pulmozyme, cystic fibrosis, medication adherence, commercially insured patients, respiratory exacerbations, hospital costs, length of hospital stay, medication possession ratio, age differences in adherence, health care utilization, health care costs, health insurance claims, prescription fills
- MeSH terms
- Adolescent, Adult, Child, Child, Preschool, Cystic Fibrosis, Deoxyribonuclease I, Female, Humans, Insurance Claim Review, Insurance, Health, Longitudinal Studies, Male, Recombinant Proteins, Retrospective Studies, Insurance Coverage, Medication Adherence, Young Adult
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