CP-052 Assessment of adherence to treatment of patients with multiple sclerosis: use of the administration database as an epidemiological database

Background Immunostimulating and immunosuppressive agents for multiple sclerosis (MS) are long-term treatments, often hardly bearable by the patients. In western countries, adherence to the treatment for chronic illnesses comes only to 50%; this is among the main causes of sub-optimal clinical results, as well as inappropriate spending. Purpose To try to use a financial compensation tool (called File F) as an epidemiological database to verify treatment adherence of MS patients followed at our centre. Materials and methods File F is a tool for tracking non-reimbursed drug compensation through the hospitalisation and outpatient rates, used in some regions as a means of compensation between different Local Health Authorities belonging to the same region or between hospitals and Local Health Authorities. We analysed the adherence to treatment of patients with MS using the indicator “proportion of days covered” (PDC) which identifies a threshold value of 80% beyond which the patient can be defined as adhering to the therapy. The analysis was performed on data extrapolated from the administration database. Results We analysed all the dispensed prescriptions data of 5 years (2008–2012) for a total of 203 patients (136 women with average age 47 years, 67 men with average age 46 years). The average incidence per year of new cases of disease was 0.107 with a trend to reduce over the 5-year period. 66% did not make changes to the treatment during the period, 26% used 2 drugs, 6% tried 3 drugs and 1.5% had used 4 medicines. There was no correlation between the time of the observation of treatment and the number of switches (R2 = 0.035). The PDC indicator shows that only 6.4% of the patients had a percentage adherence less than 80%. Analysing by the individual drugs showed that the mean adherence was greater for fingolimod, worse for patients who use interferon beta-1a by 44 mcg. In this subgroup there was no statistically significant difference (P = 0.6) between those who used the pen rather than the syringe (91.5% vs. 90%). Conclusions The administration database turned out to be as a rich tool of information and easy to use. The adherence to treatment was in reality very high. The few patients who have shown a figure less than 80% are primarily in treatment with injected forms of the drug, and this showed that there was less compliance for this route of administration than for the oral route. The pen does not seem to particularly facilitate administering the treatment. For people with low grip ability we will compare with the neurologists in order to explore the causes and effects adding to the analysis with data from the region. No conflict of interest.