ORIGINAL ARTICLE
Gout Medication Treatment Patterns and Adherence to Standards of Care From a Managed Care Perspective

https://doi.org/10.4065/81.7.925Get rights and content

OBJECTIVE

To determine allopurinol treatment patterns and adherence to published standards of care for patients with gout.

PATIENTS AND METHODS

This retrospective claims analysis in a managed care database included patients 18 years or older, with continuous eligibility for 1 year before and after the start date and 2 or more visits during which the gout disease code (274.xx) was assigned or 1 or more pharmacy prescriptions for a gout-specific medication between January 1, 2000, and December 31, 2002 (intake period). Factors associated with compliance with allopurinol therapy were measured based on the medication possession ratio, and adherence to 2 quality-of-care indicators for gout management was assessed using multivariable logistic regression analysis.

RESULTS

A total of 64.9% of allopurinol users had a modal daily dose or the most commonly observed daily dose of 300 mg/d, median length of therapy was 3 months, and a high proportion of patients had a medication possession ratio of 10% or less. Suggested quality-of-care indicators for gout had low performance: 53% of patients with renal impairment received a modal daily dose of 300 mg or greater, and 83% of patients who started taking allopurinol did not have their serum urate levels measured within 180 days. Patients with gout flares were less likely to be compliant with allopurinol (odds ratio, 0.50; 95% confidence interval, 0.40-0.63). Patients with renal impairment at baseline were 3.2 times more likely to undergo serum urate testing than patients without renal impairment (odds ratio, 3.20; 95% confidence interval, 1.25-8.23).

CONCLUSION

There was low compliance with allopurinol therapy for treatment of gout. Patients potentially received suboptimal quality of care as measured by serum urate testing and appropriateness of allopurinol dosing in patients with renal impairment.

Section snippets

Database

The study was conducted in a large southeastern US health plan database with 2.2 million patients at the time of the start of the study. The database included medical, pharmacy, and health plan eligibility data. Laboratory result data were available for a subset of the population. The types of health plans included health maintenance and preferred provider organizations. Data were available from January 1, 1999, to March 31, 2004.

Inclusion and Exclusion Criteria

Patients with either of the following 2 criteria for gout were

Patient Characteristics

A study cohort of 5942 patients with gout who were 18 years or older was identified. The prevalence of gout among all eligible patients in the study population was 1.6% (5942 of 369,356 eligible patients ≥18 years). Among patients eligible at any time who were 18 years or older, the prevalence of detected gout was 1.06% (21,404/2,017,633). Most patients (61.1%) were considered to have newly diagnosed gout because they had no medical or pharmacy claim for a gout-specific medication within 12

DISCUSSION

In the current study, 5942 eligible patients 18 years or older with medical claims for gout and/or pharmacy claims for gout-specific medications were identified from managed care data. The gout prevalence rate within the eligible members of the health plan was 1.6%. The overall prevalence of self-reported gout in the US National Health Interview Survey of 1996 among individuals older than 45 years was 4.6% in males and 2.0% in females.2 The National Institute of Arthritis and Musculoskeletal

CONCLUSION

In a large population of patients with gout, current urate-lowering medication options were not being used long term. Patients taking gout-specific medications had low allopurinol continuation rates and discontinued therapy relatively quickly. Allopurinol dosing appears to have been suboptimal to achieve the proposed target serum urate level of 6 mg/dL or lower; few patients received a modal daily dose higher than 300 mg/d. The 2 standards of care for clinical management of gout, recommended

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This study was funded by a grant from TAP Pharmaceutical Products Inc. Dr Patel and Dr Bakst are employees of TAP Pharmaceutical Products Inc. Mr Sarawate, is an employee of HealthCore, Inc; Mss Brewer and Yang are former employees of HealthCore, Inc.

Data were presented in part at the International Society for Pharmaco-economics and Outcomes Research 10th Annual Meeting, Washington, DC, May 14-16, and the American College of Rheumatology Annual Scientific Meeting, San Diego, Calif, November 12-17, 2005.

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