Compliance and persistence with Alzheimer’s disease treatment: a retrospective analysis of multiregional hospital databases in Thailand
© 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group. Aims: Due to the lack of studies evaluating compliance or persistence with Alzheimer’s Disease (AD) treatment outside High-Income Countries (HICs), this study aimed to assess compliance, persistence, and factors associated w...
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th-mahidol.519772020-01-27T17:14:22Z Compliance and persistence with Alzheimer’s disease treatment: a retrospective analysis of multiregional hospital databases in Thailand Khachen Kongpakwattana Piyameth Dilokthornsakul Charungthai Dejthevaporn Oraluck Pattanaprateep Nathorn Chaiyakunapruk Naresuan University Monash University Malaysia Faculty of Medicine, Ramathibodi Hospital, Mahidol University Medicine © 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group. Aims: Due to the lack of studies evaluating compliance or persistence with Alzheimer’s Disease (AD) treatment outside High-Income Countries (HICs), this study aimed to assess compliance, persistence, and factors associated with non-compliance and non-persistence by utilizing existing “real-world” information from multiregional hospital databases in Thailand. Materials and methods: Study subjects were retrospectively identified from databases of five hospitals located in different regions across Thailand. AD patients aged ≥60 years who were newly-prescribed with donepezil, galantamine, rivastigmine, or memantine between 2013 and 2017 were eligible for analysis. The Medication Possession Ratio (MPR) was used as a proxy for compliance, while the Kaplan–Meier survival analysis was employed to estimate persistence. Logistic and Cox regressions were used to assess determinants of non-compliance and non-persistence, adjusted for age and gender. Results: Among 698 eligible patients, mean (SD) MPR was 0.83 (0.25), with 70.3% of the patients compliant to the treatment (having MPR ≥ 0.80). Half of the patients discontinued their treatment (having a treatment gap >30 days) within 177 days with a 1-year persistence probability of 21.1%. The patients treated in the university-affiliated hospital were more likely to be both non-compliant (OR = 1.71; 95% CI = 1.21–2.42) and non-persistent (HR = 1.33; 95% CI = 1.12–1.58). In addition, non-compliance was higher for those prescribed with single AD treatment (OR = 2.52; 95% CI = 1.35–4.69), while non-persistence was higher for those unable to reimburse for AD treatment (HR = 1.34; 95% CI = 1.11–1.62). Limitations: By using retrospective databases, a difficulty in validating whether the medications are actually taken after being refilled may over-estimate the levels of compliance and persistence. Meanwhile, possible random coding errors may under-estimate the strength of association findings. Conclusions: This study reveals the situation of compliance and persistence on AD treatment for the first time outside HICs. The determinants of non-compliance and non-persistence underline key areas for improvement. 2020-01-27T10:14:22Z 2020-01-27T10:14:22Z 2019-01-02 Article Journal of Medical Economics. Vol.22, No.1 (2019), 26-34 10.1080/13696998.2018.1534739 1941837X 13696998 2-s2.0-85055468225 https://repository.li.mahidol.ac.th/handle/123456789/51977 Mahidol University SCOPUS https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85055468225&origin=inward |
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Medicine Khachen Kongpakwattana Piyameth Dilokthornsakul Charungthai Dejthevaporn Oraluck Pattanaprateep Nathorn Chaiyakunapruk Compliance and persistence with Alzheimer’s disease treatment: a retrospective analysis of multiregional hospital databases in Thailand |
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© 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group. Aims: Due to the lack of studies evaluating compliance or persistence with Alzheimer’s Disease (AD) treatment outside High-Income Countries (HICs), this study aimed to assess compliance, persistence, and factors associated with non-compliance and non-persistence by utilizing existing “real-world” information from multiregional hospital databases in Thailand. Materials and methods: Study subjects were retrospectively identified from databases of five hospitals located in different regions across Thailand. AD patients aged ≥60 years who were newly-prescribed with donepezil, galantamine, rivastigmine, or memantine between 2013 and 2017 were eligible for analysis. The Medication Possession Ratio (MPR) was used as a proxy for compliance, while the Kaplan–Meier survival analysis was employed to estimate persistence. Logistic and Cox regressions were used to assess determinants of non-compliance and non-persistence, adjusted for age and gender. Results: Among 698 eligible patients, mean (SD) MPR was 0.83 (0.25), with 70.3% of the patients compliant to the treatment (having MPR ≥ 0.80). Half of the patients discontinued their treatment (having a treatment gap >30 days) within 177 days with a 1-year persistence probability of 21.1%. The patients treated in the university-affiliated hospital were more likely to be both non-compliant (OR = 1.71; 95% CI = 1.21–2.42) and non-persistent (HR = 1.33; 95% CI = 1.12–1.58). In addition, non-compliance was higher for those prescribed with single AD treatment (OR = 2.52; 95% CI = 1.35–4.69), while non-persistence was higher for those unable to reimburse for AD treatment (HR = 1.34; 95% CI = 1.11–1.62). Limitations: By using retrospective databases, a difficulty in validating whether the medications are actually taken after being refilled may over-estimate the levels of compliance and persistence. Meanwhile, possible random coding errors may under-estimate the strength of association findings. Conclusions: This study reveals the situation of compliance and persistence on AD treatment for the first time outside HICs. The determinants of non-compliance and non-persistence underline key areas for improvement. |
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Naresuan University |
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Naresuan University Khachen Kongpakwattana Piyameth Dilokthornsakul Charungthai Dejthevaporn Oraluck Pattanaprateep Nathorn Chaiyakunapruk |
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Article |
author |
Khachen Kongpakwattana Piyameth Dilokthornsakul Charungthai Dejthevaporn Oraluck Pattanaprateep Nathorn Chaiyakunapruk |
author_sort |
Khachen Kongpakwattana |
title |
Compliance and persistence with Alzheimer’s disease treatment: a retrospective analysis of multiregional hospital databases in Thailand |
title_short |
Compliance and persistence with Alzheimer’s disease treatment: a retrospective analysis of multiregional hospital databases in Thailand |
title_full |
Compliance and persistence with Alzheimer’s disease treatment: a retrospective analysis of multiregional hospital databases in Thailand |
title_fullStr |
Compliance and persistence with Alzheimer’s disease treatment: a retrospective analysis of multiregional hospital databases in Thailand |
title_full_unstemmed |
Compliance and persistence with Alzheimer’s disease treatment: a retrospective analysis of multiregional hospital databases in Thailand |
title_sort |
compliance and persistence with alzheimer’s disease treatment: a retrospective analysis of multiregional hospital databases in thailand |
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2020 |
url |
https://repository.li.mahidol.ac.th/handle/123456789/51977 |
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1763493577591095296 |