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Table 1 (continued): Probability of achieving a correct drug
coverage by ICs (MPR ≥80%) during the study period
(Logistic Regression, n=5044)
ERS International Congress 2016, London 4-7 September 2016
INTRODUCTION
METHODS
Acknowledgments: This study was supported by GlaxoSmithKline France.
Contact: Dr Eric Van Ganse eric.van-ganse@univ-lyon1.fr
RESULTS
One-year coverage by inhaled steroids in asthma: French claims data.
Laurent Laforest1, Manon Belhassen1, Marine Ginoux1, Gilles Devouassoux2, Alain Didier3, Eric Van Ganse1, 2
1 PharmacoEpidemiology Lyon, PELyon ; HESPER 7425, Health Services and Performance Research, Université Claude Bernard Lyon 1, France 2 Respiratory Medicine, Croix Rousse Hospital, Lyon University Hospital, Lyon, France3 Respiratory Medicine, Larrey Hospital, Toulouse University Hospital, Toulouse, France
Abstract
Number:
851116
Figure 3: Distribution of individual MPR (N= 5,096)
2. Factors associated to a correct coverage by ICs (MPR ≥ 80%)
RESULTS (continued)
Study design and data source:
• A historical cohort was
identified in a 1/97th random
sample of the French national
claims data.
Study population:
• Patients aged 6-40 were
identified during an ICs
treatment episode (3 units of
ICs of a same molecule,
consecutively dispensed
within 120 days) between
2007 and 2012 (Figure 1).
Exposure to ICs:
• Durations of drug coverage
for each dispensed ICs
canister were computed
using specific prescribed
daily doses from Electronic
Medical Records (Cegedim).
• Patients’ coverage by ICs
was studied over the 12-
month study period
following the third canister
initially dispended (Figure 1),
using the the Medication
Possession Ratio (Figure 2).
Analyses:
• The distribution of individual MPRs over the 12-month study period
was described by an histogram (Figure 3).
• Factors associated to an adequate drug coverage by ICs (MPR
≥80%) were identified (logistic regression).
• Long-term adherence to inhaled corticosteroids (ICs) in persistent
asthma remains partially explored at population level in France.
• More particularly, it is unclear whether asthma patients identified
during an episode of regular ICS use remain properly treated over
subsequent months, or whether a group of irregularly treated patients
eventually appears.
• We have measured among asthma patients regularly treated by ICs
at inclusion the proportion of days covered by ICs over the 12
subsequent months and we identified the characteristics of patients
who were correctly covered by ICs during this period.
Figure 2 : Computation of the proportion of days
covered by ICs for a given patient, using
Medication Possession Ratio (MPR)
Figure 1: Patient selection and study timelines
1. Descriptive results:
• A total of 5,096 patients met
inclusion criteria.
• The study population
consisted of 42.1% of children/
teenagers (<17 year-old),
while 48.8% of patients were
females.
• Mean MPR was of 54.4% (Q1-
Q3: 31.0%-76.8%).
• Only 24% of the study
population presented MPR≥
80% during the study period
(Figure 3).
Num
ber
of patients
Table 1: Probability of achieving a correct drug coverage by
ICs (MPR ≥80%) during the study period
(Logistic Regression, n= 5,044)• Children and teenagers
presented higher MPR than
adults.
• Conversely, women tended to
have lower MPR values than
men.
• Patients receiving higher
dispensations levels of short-
acting beta-agonists were more
likely to be correctly covered by
ICs therapy.
• So were more severe asthma
patients, as identified by a long-
term disease status and/or a
past hospitalisation for asthma.
• In contrast, associated
comorbidities, free-access-to-
care status, dispensing level in
systemic corticosteroids had a
more limited impact on ICs
drug coverage.
Significantly higher probabilities
of achieving MPR ≥80% were
also observed in case of:
• Prescribed canister with 200
unit doses at index date.
• ICs prescribed by an hospital
physician at index date.
• Switch of ICs during the
study period.
• At least 3 different
prescribers of respiratory
treatments during the study
period.
• Frequent medical visits to
general practitioners during
the study period.
Conversely, no significant
statistical association appeared
with:
• The type of inhaler
dispensed at index date
• The presence of a specialist
during the study period.
• The dispensation of a
LABA/ICs fixed-dose
combination at index date.
(1) During the study period
(2) Respiratory physicians, ENT physicians, pediatricians, hospital
physicians. Specialties are not documented in the database for
hospital physicians.
(1) Free-access-to-care status which enables patients of lower
socioeconomic status to receive free medical care.
(2) 12 months before index date
(3) At least 2 quarters with treatment by antihistamines and/or nasal
corticosteroids
(4) At least 3 quarters with psychotropic treatments
(5) Long-term disease status allows patients to receive treatment for
severe and costly conditions without out-of-pocket payment.
CONCLUSIONS
• The identification of asthma patients regularly treated by ICs during several
months does not garantee any long-term adherence to therapy.
• This suggests a fragmental use of ICs over time, with drug episodes
possibly interrupted during asymptomatic periods (« no symptom, no
asthma »).
• Patients with a more severe or symptomatic asthma, more regularly
supervised by GPs and those who had their ICs therapy adjusted during the
study period tended to present a better drug coverage by ICs.
OR
95%CI
Number of doses in the ICS device dispensed at index date
<100 1.00 -
100-199 1.27 0.98-1.64
200 3.30 2.33-4.67
ICS/LABA fixed-dose combination at index date
No 1.00 -
Yes 1.05 0.83-1.32
Inhaler device at index date
Pressurized metered-dose inhaler (pMDI) 1.00 -
Dry powder inhaler multidose Diskus 0.91 0.67-1.23
Dry powder inhaler Turbuhaler 1.22 0.98-1.52
Breath-actuated device 1.26 0.89-1.78
Others 1.08 0.74-1.57
Speciality of prescriber at index date
General practitioner 1.00 -
Private practice specialist 0.99 0.81-1.20
Hospital physician 1.48 1.18-1.86
Any switch of ICS (1)
No 1.00 -
Yes 1.58 1.36-1.82
≥ 3 different prescribers of respiratory drugs (1)
No 1.00 -
Yes 1.42 1.18-1.71
Frequency of GP visits (1)
0-2 1.00 -
3-6 1.45 1.20-1.74
>6 1.79 1.47-2.19
≥ 1 visit to a specialist (1)(2)
No 1.00 -
Yes 1.04 0.89-1.22
OR
95%CI
Age groups
Adults (17-40 years) 1.00 -
Teenagers (13-16 years) 1.28 1.01-1.61
Children (6-12 years) 1.34 1.13-1.59
Gender
Male 1.00 -
Female 0.87 0.76-1.00
Free-access-to-care status (1)
No 1.00 -
Yes 1.06 0.89-1.27
Previous short-acting beta-agonists (2)
None 1.00 -
1-4 refills 0.98 0.83-1.16
≥ 5 refills 1.97 1.61-2.41
Systemic corticosteroids (2)
None 1.00 -
1-2 refills 0.87 0.75-1.01
≥ 3 refills 1.03 0.84-1.26
Rhinitis (2) (3)
No 1.00 -
Yes 1.12 0.97-1.30
Depression, anxiety (2) (4)
No 1.00 -
Yes 1.24 0.95-1.63
Long-term disease status (5) and/or hospitalization for asthma (2)
No 1.00 -
Yes 1.41 1.10-1.81
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