PERSISTENCE AND COMPLIANCE OF DEFEROXAMINE VERSUS DEFERASIROX IN MEDICAID PATIENTS WITH SICKLE-CELL DISEASE (SCD)
Author(s)
Jordan LB1, Vekeman F2, Sengupta A3, Corral M4, Guo A5, Duh MS61Sickle Cell Disease Association of America, Inc., Baltimore, MD, USA, 2Analysis Group, Inc., Washington , DC, USA, 3Analysis Group, Inc., San Francisco, CA, USA, 4Novartis Oncology, East Hanover, NJ, USA, 5Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, 6Analysis Group, Inc., Boston, MA, USA
OBJECTIVES: This study compares the frequency of hospitalizations, persistence, and compliance of SCD patients treated with deferoxamine (DFO) versus deferasirox (Exjade®), two iron chelating therapies (ICTs). METHODS: Healthcare claims from Medicaid Florida (1998-2007), Missouri (1993-2008), and New Jersey (1996-2008) were analyzed. Patients with continuous enrollment for ≥6 months prior to ICT initiation and ≥1 SCD diagnosis were included. Patients were divided into four cohorts: treated with DFO (any DFO group), treated with deferasirox (any deferasirox group), initiated on DFO and then switched to deferasirox (deferasirox switchers), and treated with deferasirox only (deferasirox only group). Frequency of hospitalization for crisis conditions related to SCD pre- and post-ICT treatment initiation was assessed. Persistence was defined as time to drug discontinuation with ≥1 Rx gap. Compliance was estimated using the medication possession ratio (MPR) based on the drug exposure. RESULTS: 217, 275, 105, and 166 patients were included in the any DFO, any deferasirox, deferasirox switchers, and deferasirox only groups, respectively. After ICT initiation, the any deferasirox and deferasirox only groups experienced a significant reduction in the per patient per month frequency of hospitalizations relative to pre-treatment (any deferasirox: from 0.09 to 0.06, P=.0105; deferasirox only: from 0.11 to 0.07, P=.0188). The Kaplan-Meier rates of medication persistence after one year of ICT were significantly greater for all three deferasirox cohorts compared to the DFO cohort (any DFO: 0.21, any deferasirox: 0.29, deferasirox switchers: 0.37, deferasirox only: 0.24). Deferasirox treated patients were also significantly more compliant than the DFO cohort (MPR, any DFO: 0.64, any deferasirox: 0.78, deferasirox switchers: 0.75, deferasirox only: 0.80). CONCLUSIONS: Deferasirox patients were more compliant and persistent to their treatment than those treated with DFO. Frequency of hospitalizations for SCD-related crisis conditions was significantly reduced in the observation period for the any deferasirox and deferasirox only groups.
Conference/Value in Health Info
2010-05, ISPOR 2010, Atlanta, GA, USA
Value in Health, Vol. 13, No. 3 (May 2010)
Code
PSY35
Topic
Patient-Centered Research
Topic Subcategory
Adherence, Persistence, & Compliance
Disease
Systemic Disorders/Conditions