Impact of noncompliance with urate-lowering drug on serum urate and gout-related healthcare costs: administrative claims analysis

• DOI: 10.1185/03007990903017966
• Publication Date: 2009-06-01T14:39:55Z
• Authors: Rachel Halpern; Reema R. Mody; Mahesh J. Fuldeore; Pankaj A. Patel; Ted R. Mikuls
• Keywords: Adult; Aged, 80 and over; Male; Gout; Allopurinol; Comorbidity; Health Care Costs; Middle Aged; Uricosuric Agents; Uric Acid; 3. Good health; Insurance Claim Review; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Humans; Patient Compliance; Drug Therapy, Combination; Female; Aged

To determine the association between allopurinol compliance and serum urate (sUA) level; examine sUA gout-related healthcare costs in a large managed care population.This retrospective administrative claims analysis examined subjects with gout (> or = 2 medical ICD-9-CM diagnosis code 274.xx > 1 claim pharmacy for allopurinol, probenecid, colchicine, sulfinpyrazone) January 1, 2002 March 31, 2004. Each subject was observed during 1-year pre-index post-index periods.Outcomes were medication possession ratio (MPR) (MPR 0.80), (mg/dL), costs. 'Post-allopurinol' measured three periods after first fill: 30-89 days; 90-149 150 days. A baseline on before start of period also identified. Outcomes stratified by post-allopurinol compliance. Generalized linear modeling (GLM) regression impact costs, controlling demographic health status variables.The study sample comprised 18,243 mean age 53.9 years. In all, 55% (n 10,073) used allopurinol. There 1473 (8.1%) 2438 (13.4%) result. Among all sUA, 45.6% compliant; 49.3% 56.8% compliant had an < 6.0 mg/dL compared 22.5-27.8% non-compliant subjects, depending time (all p 0.001). GLM results showed associated 9.0 58% higher (95% confidence interval (CI): 1.012 -2.456; 0.044) than mg/dL. no significant difference mg/dL.Analysis revealed important associations compliance, costs: positively favorable (<6.0 mg/dL) unadjusted comparisons. that inversely relative to <9.0 Nevertheless, substantial portion even ones, did not achieve These should be interpreted carefully light limitations, including incomplete laboratory data, potentially incorrect inference medications taken as prescribed, lack generalizability from Medicare enrollees broader population.