Using a learning health system to understand the mismatch between medicines supply and actual medicines use among adults with cystic fibrosis.

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Bevan, Amanda, Hoo, Zhe Hui, Totton, Nikki, Girling, Carla, Davids, India R, Whelan, Pauline, Antrobus, Steven, Ainsworth, John, Buchan, Iain ORCID: 0000-0003-3392-1650, Anderson, Alan et al (show 58 more authors) , Bourke, Stephen, Doe, Simon, Echevarria, Carlos, Taylor, Jill, Bell, Nicholas J, Bateman, Kathryn, Jones, Carys, Moran, Peter, Fitch, Giles, Martin, Michael, McGowan, Angela, Morrow, Stephen, Seabridge, Heather, Bush, Nicki, Daniels, Tracey, Lee, Katy, Robson, Nicola, Shiferaw, Dejene, Sweis, Dimah, Thomas, Rebecca, Faulkner, Jayne, Flight, William G, Poole, Sarah, Warnock, Louise, Allenby, Mark I, Carroll, Mary, Daniels, Thomas V, Dunn, Helen, Nightingale, Julia A, Shepherd, Elizabeth, Ohri, Chandra, Gadsby, Jessica, Range, Simon, Tature, Darren, Barr, Helen L, Dawson, Sophie, Dewar, Jane, Miller, Bryony, Saini, Gauri, Galey, Penny, Johnson, Jack, Pasteur, Mark C, Derry, David, Gledhill, Harriet, Lawson, Angharad, Thomas, Michelle, Waine, David, Cunningham, Josie, Damani, Annant, Higton, Alexandra, Orchard, Christopher, Carolan, Charlotte, Tahir, Misbah, Plummer, Amanda, Hutchings, Marlene, Edenborough, Frank P, Curley, Rachael and Wildman, Martin J (2021) Using a learning health system to understand the mismatch between medicines supply and actual medicines use among adults with cystic fibrosis. Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society, 21 (2). pp. 323-331.

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Abstract

<h4>Background</h4>Studies in separate cohorts suggest possible discrepancies between inhaled medicines supplied (median 50-60%) and medicines used (median 30-40%). We performed the first study that directly compares CF medicine supply against use to identify the cost of excess medicines supply.<h4>Methods</h4>This cross-sectional study included participants from 12 UK adult centres with ≥1 year of continuous adherence data from data-logging nebulisers. Medicine supply was measured as medication possession ratio (MPR) for a 1-year period from the first suitable supply date. Medicine use was measured as electronic data capture (EDC) adherence over the same period. The cost of excess medicines was calculated as whole excess box(es) supplied after accounting for the discrepancy between EDC adherence and MPR with 20% contingency.<h4>Results</h4>Among 275 participants, 133 (48.4%) were females and mean age was 30 years (95% CI 29-31 years). Median EDC adherence was 57% (IQR 23-86%), median MPR was 74% (IQR 46-96%) and the discrepancy between measures was median 14% (IQR 2-29%). Even with 20% contingency, mean potential cost of excess medicines was £1,124 (95% CI £855-1,394), ranging from £183 (95% CI £29-338) for EDC adherence ≥80% to £2,017 (95% CI £1,507-2,526) for EDC adherence <50%.<h4>Conclusions</h4>This study provides a conservative estimate of excess inhaled medicines supply cost among adults with CF in the UK. The excess supply cost was highest among those with lowest EDC adherence, highlighting the importance of adherence support and supplying medicine according to actual use. MPR provides information about medicine supply but over-estimates actual medicine use.

Item Type:	Article
Uncontrolled Keywords:	Cystic fibrosis, Adherence to therapy, Measurement systems, Cost analysis
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Population Health
Depositing User:	Symplectic Admin
Date Deposited:	20 Dec 2021 09:50
Last Modified:	18 Jan 2023 21:18
DOI:	10.1016/j.jcf.2021.09.007
Open Access URL:	https://eprints.whiterose.ac.uk/179711/
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3145676