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P581. 5-ASA medication adherence comparison in Latvia and Estonia

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

Background

5-ASA preparations are the mainstay treatment of inflammatory bowel diseases but previous studies have shown that the adherence to their daily use varies greatly. Lack of adherence increases treatment expenses and facilitates development of exacerbation [1]. Although it has been shown to be dependent of patient co-payments [2], Latvia which had a 25% co-payment in 2006/7 increased it to 50% in 2009. For comparison Estonia on the contrary has maintained a 25% patient co-payment throughout these years. Therefore it was suspected that the higher patient co-payments would correlate with lower adherence values.

Methods

As the currently available national medication consumption data cannot be broken down to disease level, the National Health Service in Latvia, Lithuania and Estonia were asked for a random, anonymous sample of patient data, about patients who had received mesalazine in years 2006/7 and 2011/12 for the treatment of an inflammatory bowel disease. From the provided data set, which contained information about state reimbursed medications (date and amount of drug reimbursed) and basic demographic information (age and gender) the purchased number of daily doses per year/per patient were calculated. It was then compared to the expected number of DDD (2g per day) that ought to have been purchased in case of high adherence.

Results

The respective Institution in Lithuania responded that they are technically unable to provide the requested data. Data about 408 patients from Estonia (219 males and 189 females), average age 44.0 years, and 117 patients from Latvia (49 males and 68 females) with average age 49.9 years was received. Of those only 63 patients from Latvia and 56 from Estonia had prescription data from all 4 years of interest.

In Latvian sample the number of patients taking at least 80% of the medication decreased significantly from 65% to 57% (p = 0.04), whereas in Estonian one there was an increase from 60.8% in 2006/2007 to 67.4% in 2011/2012, although it was not statistically significant (p = 0.15).

Also the number of patients taking less than 25% of the expected DDDs slightly increased in Latvia, whereas the opposite trend could be seen in Estonia, but the numbers didn't reach statistical significance.

Conclusion

The previously described influence of patient co-payments to the medication adherence was also observed in this small sample. It seems reasonable to conclude that the decision in Latvia to increase the patient's co-payments from 25% to 50% has influenced, if not caused, a decrease in adherence to mesalazine. In Estonia, where the co-payments have remained the same throughout the years, the adherence rates show a tendency to improve.

1. Higgins PD, Rubin DT, Kaulback K, Schoenfield PS, Kane SV (2009), Systematic review: impact of non-adherence to 5-aminosalicylic acid products on the frequency and cost of ulcerative colitis flares., Aliment Pharmacol Ther., Feb 1; 29(3): 247–57.

2. 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.