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Persistence with overactive bladder pharmacotherapy in a Medicaid population
Fadia T Shaya1, Steven Blume, Anna Gu
1Center on Drugs and Public Policy, University of Maryland School of Pharmacy, Baltimore, USA.
The American Journal of Managed Care
|September 16, 2005
Summary
Medicaid patients with overactive bladder (OAB) showed better medication persistence with once-daily long-acting agents (tolterodine ER, oxybutynin ER) compared to immediate-release oxybutynin (oxybutynin IR). Further research is needed on non-persistent patients.
Area of Science:
- Pharmacoeconomics and Health Outcomes Research
- Urology and Nephrology
- Chronic Disease Management
Background:
- Patient adherence to medication is a significant challenge in managing chronic conditions like overactive bladder (OAB).
- This study evaluates medication persistence for OAB treatments within the Medicaid population.
- Comparing adherence across different OAB drug formulations is crucial for improving patient outcomes.
Purpose of the Study:
- To compare medication persistence rates among Medicaid patients prescribed tolterodine ER, oxybutynin ER, or oxybutynin IR for OAB.
- To identify factors influencing adherence to OAB medications.
- To inform strategies for enhancing patient compliance in OAB management.
Main Methods:
- A retrospective analysis of continuously enrolled Medicaid patients from January 1, 2000, to December 31, 2003.
- Inclusion criteria focused on new users of tolterodine ER, oxybutynin ER, or oxybutynin IR.
- Survival analyses, adjusted for demographic factors, were used to assess persistence and possession time.
Main Results:
- Only 32% of oxybutynin IR users and 44% of long-acting agent users remained adherent past 30 days.
- Patients on oxybutynin ER had a higher risk of nonadherence compared to tolterodine ER (HR=1.47).
- The study included 1637 patients, with a majority being women and a significant proportion being African American.
Conclusions:
- Once-daily dosing of long-acting OAB agents is associated with improved medication persistence.
- Understanding the reasons for non-persistence in OAB patients is essential for developing targeted interventions.
- Findings highlight the importance of formulation and dosing frequency in medication adherence for chronic conditions.