Factors Associated With Adherence to First-line Antiviral Therapy Among Commercially Insured Patients With Chronic Hepatitis B

by Selleckchem | May 01 2023

Background: Nonadherence to antiviral therapy can lead to poor clinical outcomes among patients with chronic hepatitis B (CHB). We used a claims database to evaluate risk factors for nonadherence to antiviral therapy among commercially insured patients with CHB in the United States.

Methods: We obtained data for commercially insured adult patients with CHB prescribed entecavir or tenofovir disoproxil fumarate (TDF) in 2019. Primary outcomes were adherence to entecavir and adherence to TDF. Enrollees with a proportion of days covered (PDC) ≥80% were considered adherent. We presented adjusted odds ratios (AORs) from multivariate logistic regressions.

Results: Eighty-three percent (n = 640) of entecavir patients were adherent, and 81% (n = 687) of TDF patients were adherent. Ninety-day supply (vs 30-day supply; AOR, 2.21; P < .01), mixed supply (vs 30-day supply; AOR, 2.19; P = .04), and ever using a mail order pharmacy (AOR, 1.92, P = .03) were associated with adherence to entecavir. Ninety-day supply (vs 30-day supply; AOR, 2.51; P < .01), mixed supply (vs 30-day supply; AOR, 1.82; P = .04), and use of a high-deductible health plan (vs no high-deductible health plan; AOR, 2.29; P = .01) were associated with adherence to TDF. Out-of-pocket spending of >$25 per 30-day supply of TDF was associated with reduced odds of adherence to TDF (vs <$5 per 30-day supply of TDF; AOR, 0.34; P < .01).

Conclusions: Ninety-day and mixed-duration supplies of entecavir and TDF were associated with higher fill rates as compared with 30-day supplies among commercially insured patients with CHB.

Comments：

The study evaluated risk factors for nonadherence to antiviral therapy among commercially insured patients with chronic hepatitis B (CHB) in the United States, using a claims database. Data for adult patients with CHB who were prescribed entecavir or tenofovir disoproxil fumarate (TDF) in 2019 were obtained. The primary outcomes were adherence to entecavir and adherence to TDF, and enrollees with a proportion of days covered (PDC) ≥80% were considered adherent. Adjusted odds ratios (AORs) from multivariate logistic regressions were presented.

The results showed that 83% of entecavir patients were adherent, while 81% of TDF patients were adherent. The study found that 90-day and mixed-duration supplies of entecavir and TDF were associated with higher fill rates as compared with 30-day supplies among commercially insured patients with CHB. Other factors associated with adherence to entecavir were ever using a mail order pharmacy, while for TDF, use of a high-deductible health plan was associated with adherence. On the other hand, out-of-pocket spending of >$25 per 30-day supply of TDF was associated with reduced odds of adherence to TDF.

In conclusion, the study suggests that longer-duration supplies of entecavir and TDF and use of mail order pharmacies may improve adherence among patients with CHB. Additionally, the study highlights the potential impact of high out-of-pocket costs on medication adherence.