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P391. Patient co-payments in Latvia and Estonia and the use of azathioprine

V. Mokricka, E. Krustins, A. Pukitis, J. Pokrotnieks, Pauls Stradins Clinical University Hospital, Centre of Gastroenterology, Hepatology and Nutrition, Riga, Latvia


One of the largest problems in treatment of chronic diseases is the patients' compliance and long-term regular use of medication [1]. One reason, which may reduce the use of drugs that are essential for chronically-ill patients, are the co-payments for prescribed drugs, as patients with chronic health problems frequently have difficulties affording their therapy and as a result fail to take their medication as prescribed. Therefore the aims of this study were to assess whether the association between patients co-payments and azathioprine adherence for inflammatory bowel diseases in Baltic countries.


Upon authors' request the National Health Services in Latvia and Estonia provided information at patient level about a random group of patients receiving azathioprine, who purchased state reimbursed medication both in 2006/7 and in 2011/12 (the National Health Service of Lithuania declined releasing the data due technical reasons). The medication consumption was assessed based on the number of state-reimbursed recipes that were claimed at pharmacies each year. From that the amount of Defined Daily Doses (DDD) purchased each year was calculated for each patient and this amount was than compared to the expected number of DDD a patient would need per year.


Co-payment in Latvia currently is 50% (up from 25% in 2006) whereas in Estonia it has been 25% since 2006. The study population included 340 patients, of whom 305 patients were from Estonia (mean age: 38.37 years; 47% females, 53% males) and 35 were from Latvia (mean age: 46.48 y; 60% females, 40% males). No data was provided from Estonia about years 2006/7.

In 2012 88.6% of patients in Estonia had acquired used at least 80% of the expected DDD, whereas in Latvian group there were 87.5% such patients. Comparing 2006/7 to 2011/12 when the copayment was increased, an insignificant increase from 90% to 93% (p > 0.05) was observed. In Estonia an increase from 81.5% in 2011 to 88.6% in 2012 (p = 0.001) was observed. But comparison between Latvia and Estonia didn't reveal significant differences (p > 0.05).


The overall adherence to azathioprine use both in Latvia and Estonia seems to be high [2], but the fact that for many patients the daily dose is higher that the DDD of 15 mg, makes on think that the actual adherence might be significantly lower. Also the seemingly increase in adherence in Latvia despite the co-payment increase is most likely confounded by the low number of patients or some other factors, like greater awareness of the necessity of treatment.

1. Zeber JE, Manias E, Williams AF, Hutchins D, Udezi WA, Roberts CS, Peterson AM; ISPOR Medication Adherence Good Research Practices Working Group (2013), A systematic literature review of psychosocial and behavioral factors associated with initial medication adherence: a report of the ISPOR medication adherence & persistence special interest group. Value Health, Jul-Aug; 16(5): 891–900.

2. Stocco G, Londero M, Campanozzi A, Martelossi S, Marino S, Malusa N, Bartoli F, Decorti G, Ventura A (2010), Usefulness of the measurement of azathioprine metabolites in the assessment of non-adherence. J Crohns Colitis, 2010 Nov; 4(5): 599–602.