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ObjectivesTo measure the association of transplant patients’ personality, depression, and quality of life with medication adherence in kidney and liver transplant recipients.MethodsA cross-sectional study of liver and kidney transplant recipients greater than 1 year post-transplant was conducted. Patients’ adherence with medications was assessed using the Immunosuppressive Therapy Adherence Scale. Personality and depression were assessed using the NEO Five-Factor Inventory Scale and Patient Health Questionnaire 9, respectively. Quality of life was assessed using the Short Form-36, and functional status was determined using the Karnofsky Performance Status Scale.ResultsA total of 86 kidney and 50 liver transplant patients completed the surveys. Logistic regression analysis demonstrated an association between depression and adherence with immunosuppressive medications in kidney transplant recipients. Kidney transplant patients who exhibited “low openness” scores were 91% more likely to be nonadherent. Kidney transplant patients’ physical functional status was strongly associated with nonadherence, and for each point increase in functionality the patients’ adherence increased by 4%. In the liver sample, age was associated with adherence. For every year increase in age, adherence increased by 7%.ConclusionThe presence of low openness as a personality trait, poor physical functional status, and depression were associated with adherence in the kidney transplant population. In the liver transplant population, younger age was associated with nonadherence.

BACK GROUND: Although it is well-known that drug costs in the US have risen precipitously over the last 25 years, what is much less appreciated is how this risein cost has occurred across so manyseeminglydistinctdrug markets. OBJECTIVE: To describe trends in the utilization, spending, and average perprescription costof benzodiazepines individually, in subgroups, and overall, in the Medicaid program. Medicaid has been the primarypublic payer for benzodiazepinesover the past2 decades. METHODS: A retrospective, descriptive analysis was performed for the years 1991-2009using the publiclyavailablenationalSummary Files fromthe Medicaid State Drug Utilization Datamaintained by the Centers for Medicare & Medicaid services. Quarterly prescription countsand reimbursement amounts were calculated for all benzodiazepines reimbursed by Medicaid. Average per-prescription spending as a proxy for drug price was found by dividing reimbursement by the number of prescriptions. RESULTS: Prescriptions for benzodiazepines among Medicaid beneficiaries Increased from8.0 million in 1991 to 17.1 million in 2009. Expenditures rose from $131 .6 million to $171.1 million over the sametime period. The average per-prescription price was a little over$10 in 2009. Whereas utilization of intermediate-and long-acting agents increased overtime, prescriptions for short-acting drugs fell from 1.1 million to 0.3 million (1991-2009). The percentage rise in Medicaid spendingon benzodiazeplnes since 1991 (30.0%) was less than the generalrate of inflation (57.5%), as measured by the percentagechange in the consumer price index overthe sametime period. CONCLUSIONS: Relative to the rise in the numberof Medicaid beneficiaries (more thandoubled over the studyperiod), there is no evidence of an extraordinaryrise in the utilization of benzodiazepines. Moreover, both nominal and real average prices of benzodiazepines have fallen, primarily becauseof generic entry over the last 2 decades.

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