During 1998, digestive diseases accounted for $85.5 billion in total direct medical costs and $22.8 billion in indirect costs. In 1996, approximately 70 million people were affected by digestive diseases. This translates to about 234,000 lives that are lost every year as a result of digestive illnesses. Digestive diseases account for 9% of all hospitalizations and 14% of all in-patient procedures. Incidence rates for specific illnesses are relatively high, estimated at 160 per 100,000 for infectious disease, 8 per 100,000 for ulcerative colitis, and 7 per 100,000 for Crohn’s disease.
Pharmacotherapy for gastrointestinal (GI) diseases is costly. About $138 million was spent on medications for ulcerative colitis in the U.S. during 1998. More than $10 billion per year is spent on proton pump inhibitors (PPIs) in the U.S. Furthermore, 23 drugs used for GI treatment made it to the top 200 generic drugs used in 2004. Advances in the treatment of inflammatory bowel disease (IBD) include delayed-release (e.g., Shire), balsalazide disodium (Colazal, Salix), and olsalazine (Dipentum, Pfizer) for treating and maintaining remission of ulcerative colitis, and (Azulfidine canadian, Pfizer) for the treatment of bowel inflammation, diarrhea, rectal bleeding, and abdominal pain in patients with ulcerative colitis.
Many factors affect health outcomes and costs of treatment— among them, how patients comply with their therapy. Recent literature has emphasized the importance of adherence to therapy in general, especially for patients with digestive diseases. Although several studies in different therapeutic areas have shown evidence that adherence to therapy improves health care outcomes, only about a third of patients adhere to their health care provider’s recommendations.
Although pharmacoepidemiologic research on adherence to GI pharmacotherapy is limited, a study by Kane et al. found that only 40% of patients with clinically quiescent ulcerative colitis adhered to their therapy. “Adherence” was defined as the ratio of the sum of the day’s supply to the length of therapy. The major factors associated with non-adherence were the patient’s sex, marital status, and concomitant medications. The quality of the physician-patient relationship was also an important factor associated with adherence to therapy.
Given the burden of non-adherence and non-persistence (i.e., not filling a prescription) with therapy for ulcerative colitis and the rising attention focused on health policy decision-makers to implement programs to decrease costs related to health care, our study’s aim was to determine the association between persistence with GI pharmacotherapy (consisting of amino-salicylates) and health care costs from the payer’s perspective.
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