Add Back Therapy Use Among Endometriosis Patients Initiating Leuprolide Acetate (La) Therapy: Association With Improved Adherence And Lower Surgery Rates In A Cohort Of Commercially Insured Women

Abstract

Objectives: To describe the impact of add-back therapy on adherence and surgery rates among endometriosis patients starting leuprolide acetate (LA) therapy. Hormonal add-back therapy is used in conjunction with LA treatment of endometriosis patients to reduce potential side effects associated with LA gonadotropin releasing hormoneagonist effects. MethOds: Truven Health MarketScan Commercial Encounters database was used to identify women aged 18-49 with endometriosis (ICD-9-CM code 617. xx) who initiated LA (index date) in 2005-2011. Women with 12 months of continuous enrollment pre-and post-index and no evidence of endometriosis-related surgeries pre-index or up to 30 days post-index, no pre-index use of estrogen or non-contraceptive hormones and no diagnoses of uterine fibroids, malignant neoplasms, infertility, or pregnancy were included in the analysis. Proportion of patients adherent to LA, measured by Medication Possession Ratio (MPR)≥ 0.80, and time to endometriosis-related surgery in the post-index period were compared between patients with no add back therapy, patients who used norethindrone/norethindrone acetate (NETA) add-back and patients who used other add-back (estrogens, progestins, or combinations) using logistic and Cox Proportional Hazard regression models controlling for demographics, comorbidities and pain medication use. Results: Final study sample included 3,114 women with mean age 36.9 years. The majority of women did not use add-back (n= 1,965, 63.1%) while 22.9% used LA with NETA (n= 713) and 14% used other add-back (n= 436). NETA patients had higher likelihood of being adherent to LA than other addback patients (OR= 1.4, 95% CI (1.1, 1.8)) or non-add-back patients (OR= 2.2, 95% CI (1.8, 2.6)). NETA patients had lower surgery rate in the 12-months post-index compared to other add-back (HR= 0.62, 95% CI (0.46, 0.83) or non-add-back patients (HR= 0.72, 95% (CI 0.57, 0.91)). cOnclusiOns: Use of add-back therapy, particularly norethindrone/ NETA add-back, was associated with improved adherence to LA and reduced rates of endometriosis-related surgery, which has substantial economic and patient burden.Objectives: To assess parents' knowledge and practice about childhood immunization, and to determine the impact of their knowledge and practice on their children immunization status. MethOds: Children immunization timeliness was evaluated using a retrospective cohort study design. The data were collected from ten public clinics in the state of Pahang, the largest state in peninsular Malaysia. Immunization related information was collected from the child's immunization record card obtained from the parents. Parents' knowledge and practice was evaluated using a prospective cross-sectional study design by answering validated knowledge and practice questionnaire. Data were analyzed using SPSS version 20.0. Mean and median for the total knowledge and practice score were calculated. Parents' knowledge and practice was dichotomized into adequate and inadequate using median split method. Chi-square test wa...