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Original Research: Genetic and Developmental Disorders |

Pulmonary Medication Adherence and Health-care Use in Cystic FibrosisPulmonary Medication Adherence in Cystic Fibrosis

Alexandra L. Quittner, PhD; Jie Zhang, PhD; Maryna Marynchenko, MBA; Pooja A. Chopra, MS; James Signorovitch, PhD; Yana Yushkina, BA; Kristin A. Riekert, PhD
Author and Funding Information

From the Department of Psychology (Dr Quittner), University of Miami, Coral Gables, FL; Novartis Pharmaceuticals Corp (Dr Zhang), East Hanover, NJ; Analysis Group, Inc (Mss Marynchenko, Chopra, and Yushkina and Dr Signorovitch), Boston, MA; and Division of Pulmonary and Critical Care Medicine (Dr Riekert), The Johns Hopkins University School of Medicine, Baltimore, MD.

CORRESPONDENCE TO: Alexandra L. Quittner, PhD, Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL 33146; e-mail: aquittner@miami.edu


Parts of this study have been reported in abstract form at the 26th Annual North American Cystic Fibrosis Conference, October 11-13, 2012, Orlando, FL.

FUNDING/SUPPORT: This study was supported by the Novartis Pharmaceuticals Corp, which manufactures inhaled tobramycin.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(1):142-151. doi:10.1378/chest.13-1926
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BACKGROUND:  Poor treatment adherence is common in cystic fibrosis (CF) and may lead to worse health outcomes and greater health-care use. This study evaluated associations of adherence to pulmonary medications, age, health-care use, and cost among patients with CF.

METHODS:  Patients with CF aged ≥ 6 years were identified in a national commercial claims database. A 12-month medication possession ratio (MPR) was computed for each pulmonary medication and then averaged for a composite MPR (CMPR) for each patient. The CMPR was categorized as low (< 0.50), moderate (0.50-0.80), or high (≥ 0.80). Annual health-care use and costs were measured during the first and second year and compared across adherence categories by multivariable modeling.

RESULTS:  Mean CMPR for the sample (N = 3,287) was 48% ± 31%. Age was inversely related to CMPR. In the concurrent year, more CF-related hospitalizations were observed among patients with low (event rate ratio [ERR], 1.35; 95% CI, 1.15-1.57) and moderate (ERR, 1.25; 95% CI, 1.05-1.48) vs high adherence; similar associations were observed for all-cause hospitalizations and CF-related and all-cause acute care use (hospitalizations + ED) in the concurrent and subsequent year. Rates of CF-related and all-cause outpatient visits did not differ by adherence. Low and moderate adherence predicted higher concurrent health-care costs by $14,211 ($5,557-$24,371) and $8,493 (−$1,691 to $19,709), respectively, compared with high adherence.

CONCLUSIONS:  Worse adherence to pulmonary medications was associated with higher acute health-care use in a national, privately insured cohort of patients with CF. Addressing adherence may reduce avoidable health-care use.

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