Abstract
Phosphodiesterase-5 inhibitors (PDE-5I) have demonstrated improvement in disease symptoms and quality of life for patients with pulmonary arterial hypertension (PAH). Despite these benefits, reported adherence to PDE-5I therapy is sub-optimal. Clinical pharmacists at an integrated practice site are in a unique position to mitigate barriers related to PAH therapy including medication adherence and costs. The primary objective of this study was to assess medication adherence to PDE-5I therapy within an integrated care model at an academic institution. The secondary objective was to assess the impact of out-of-pocket (OOP) cost, frequency of dosing, adverse events (AE) and PAH-related hospitalizations on medication adherence. We performed a retrospective cohort analysis of adult patients with PAH who were prescribed PDE-5I therapy by the center’s outpatient pulmonary clinic and who received medication management through the center’s specialty pharmacy. We defined optimal medication adherence as proportion of days covered (PDC) ≥ 80%. Clinical data including AEs and PAH-related hospitalizations were extracted from the electronic medical record, and financial data from pharmacy claims. Of the 131 patients meeting inclusion criteria, 94% achieved optimal adherence of ≥ 80% PDC. In this study population, 47% of patients experienced an AE and 27% had at least one hospitalization. The median monthly OOP cost was $0.62. Patients with PDC<80% were more likely to report an AE compared to patients with PDC≥ 80% (p = 0.002). Hospitalization, OOP cost, and frequency of dosing were not associated with adherence in this cohort. Patients receiving PDE-5I therapy through an integrated model achieved high adherence rates and low OOP costs.
Highlights
Pulmonary hypertension (PH) is a chronic, progressive disease characterized by elevated pulmonary vascular pressure.[1]
Pulmonary arterial hypertension (PAH) is a subgroup of PH characterized by pre-capillary PH
Phosphodiesterase-5 inhibitors (PDE-5I) are a class of medications approved for the treatment of PAH.[4]
Summary
Pulmonary hypertension (PH) is a chronic, progressive disease characterized by elevated pulmonary vascular pressure.[1]. Phosphodiesterase-5 inhibitors (PDE-5I) are a class of medications approved for the treatment of PAH.[4] The goals of pharmacotherapy include improvement in disease symptoms and quality of life as well as prevention of disease progression.[1] Two commonly prescribed PDE-5Is are sildenafil (Revatio, Pfizer Inc., New York City, New York, USA) and tadalafil (Adcirca, Eli Lilly and Company, Indianapolis, Indiana, USA). Sildenafil demonstrated improvement in 6-minute walk distance (6MWD) and functional class as well as cardiopulmonary hemodynamics.[5] Tadalafil demonstrated improvement in 6MWD, exercise capacity and quality of life as well as a reduction in clinical worsening.[6] clinical effects of treatment are dependent on medication adherence. PDE-5Is and endothelin receptor antagonists, generally in combination, are used commonly for low-risk patients with PAH.[8]
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