Objective. To investigate the determinants of health care utilization and costs with use of glucocorticoid (GC) drugs among adult systemic lupus erythematosus (SLE) patients. Methods. This cross-sectional study analyzed established SLE patients identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes from a large US insurance claims database in 2007-2011. Five patient groups were defined by their oral GC use during a 1-year period: non-GC users, <60 days of GC use, and ‡60 days of GC use in low dosage (£7.5 mg/day), medium dosage (>7.5 to £15 mg/day), or higher dosage (>15 mg/day). Annual health care utilization and costs were compared across these groups. Incremental costs of GC groups, calculated as the difference in total health care costs compared with those of the non-GC group, were estimated from multivariable regressions adjusting for demographic/clinical characteristics and stratified by concomitant immunosuppressant use. Results. A total of 50,230 SLE patients were identified (52% non-GC users, 20% <60 days of GC use, and 10% low dose, 10% medium dose, and 8% higher dose of ‡60 days of GC use). GC users had higher health care utilization and costs. Incremental costs were significant (all P < 0.01) for medium-dose ($5,319 and $6,913) and higher-dose ($12,517 and $15,019) GC groups, regardless of concomitant immunosuppressant use. The incremental costs for the low-dose GC group with concomitant immunosuppressants ($1,285; P 5 0.04) were smaller than the incremental costs for the low-dose GC group without concomitant immunosuppressants ($2,514; P < 0.01). Conclusion. GC use, especially at higher doses, was associated with higher health care utilization and costs. Findings in users with concomitant immunosuppressants suggest that therapies with a GC-sparing effect may be associated with lower economic burden in SLE treatment.

Pattern of use was very dynamic, suggesting seizures are not well-controlled. Improving seizure control and reducing economic burden of refractory epilepsy remain important unmet medical needs in this population.

BAckgROund: Warfarin is the predominant oral anticoagulant used for the prevention of recurrent venous thromboembolism (VTE) events. However, its long-term use is complicated by the need to manage the drug within a narrow therapeutic range and by possible food and drug interactions.

Long-term adherence to statins is poor. We assessed the relationship between cardiovascular (CV) risk and atorvastatin adherence in primary- and secondary-prevention patients, adjusting for healthy-adherer bias by incorporating preventive service use into the model. Medical and pharmacy claims from employee-based plans from 2002 to 2008 were analyzed for patients who initiated atorvastatin in 2003-2004. Adherent patients were defined as having ≥60% of days covered in the year after atorvastatin initiation and were required to have pill coverage in months 10-12. CV events were identified as hospitalizations with a primary CV diagnosis and assessed from month 13 after atorvastatin initiation until the end of follow-up (≤36 months). Cox proportional hazards models were used to examine the association between atorvastatin adherence and CV event risk, adjusting for covariates including preventive service use. The study included 94,287 atorvastatin users (79,010 primary- and 15,277 secondary-prevention patients). In both populations, nearly one-half of the patients discontinued atorvastatin after 1 year. During follow-up, ~2% of primary-prevention and ~9% of secondary-prevention patients experienced CV events. After adjusting for covariates, adherent patients in the primary-prevention population had a significantly lower risk of CV events compared with nonadherent patients (hazard ratio, 0.82; 95% confidence interval, 0.74-0.91). In the secondary-prevention population, adherence to atorvastatin was also associated with lower CV risk (hazard ratio, 0.74; 95% confidence interval, 0.66-0.82). Atorvastatin discontinuation rates were high 1 year after treatment initiation. Patients who adhered to atorvastatin treatment were at lower CV risk. Quality-of-care interventions should target improvements to therapy persistence.

Adherence to PDE5Is for PAH is sub-optimal. The findings suggest that adherence to PDE5Is in patients with PAH is associated with the use of specialty pharmacy, simpler dosing frequency, a lower financial barrier, and a prescription given by pulmonologists.