The study objective was to determine the association between immunosuppressant therapy (IST) adherence and graft failure among pediatric renal transplant recipients (RTRs) using data reported in the United States Renal Data System (USRDS), which contains Medicare prescription claims. RTRs (≤18 years) who received their only transplant during 1995-2000, experienced graft survival more than 6 months posttransplant, had 36 months of USRDS data (or had data until graft failure or death), utilized Medicare IST coverage, and were prescribed cyclosporine/tacrolimus were included. IST adherence was measured by medication possession ratio (MPR). Cox proportional hazards analysis was used to assess the relationship between time to graft failure and continuous MPR. MPR quartiles were used to examine MPR as a categorical variable (Quartile 4 = adherent group, Quartiles 1-3 = nonadherent group). Kaplan-Meier estimates of time to graft failure were compared between adherent and nonadherent groups. 877 RTRs met inclusion criteria. Cox proportional hazards modeling suggested that greater adherence was significantly associated with longer time to graft failure (p = 0.009), after adjusting for relevant clinical factors. Kaplan-Meier analysis found a difference between adherent and nonadherent groups in graft survival by time (v 2 = 5.68, p = 0.017). Interventions promoting adherence should be implemented among pediatric RTRs and parents/guardians to optimize graft survival.

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OBJECTIVES: Asthma is a common medical condition that is increasing in prevalence. The purpose of this study was to examine costs associated with treating asthma patients within a managed care organization (MCO). METHODS: Data for this study were obtained from a managed care organization located in the Western region of the US. Patients were eligible for inclusion if they met one of the following criteria: a diagnosis of asthma (ICD‐9 code of 493.xx); two or more prescriptions used to control asthma (e.g., inhaled corticosteroid, leukotriene modifier, mast cell stabilizer, xanthine derivative, or a long acting beta agonist); or one prescription for an asthma controller and one or more prescriptions for a short acting beta‐agonist. Patients also had to be full year members of the MCO. Patients with a diagnosis of chronic obstructive lung disease were excluded. RESULTS: A total of 351,140 persons were continuously enrolled in the MCO during 1999. A total of 8,051 persons were identified as having asthma (2.3% of the MCO enrollees), with 43% being male. Persons under 18 years of age comprised 28.8% of persons with asthma. Median pharmacy costs were $472, median medical costs were $483, and median total health care costs were $1199 for this population. CONCLUSIONS: Asthma appears to affect a significant number of enrollees within this MCO, with persons less than 18 years of age representing almost 29% of the treated patients. Health care costs in persons with asthma appears to be substantial.