BACKGROUND: In the Swedish reimbursement scheme, the co-payment is based on the price of the product and decreases in a stepwise manner as the total accumulated co-payment increases. The aim of this study was to analyse how refill adherence in Sweden varies according to patient's co-payment level for medicines, with antiepileptic drug (AED) use as an example. METHODS: Prevalent AED users aged 18-85 years who purchased an AED between 1 January and 30 June 2007 were identified in the Swedish Prescribed Drug Register and followed for a maximum of 2 years. Patient time was categorized based on patient's accumulated co-payment for all drugs per reimbursement period. The continuous measure of medication acquisition (CMA) was used to estimate refill adherence in relation to the patients' co-payment level. Associations between patients' co-payment for all medicines and refill adherence were assessed with multilevel mixed-effects linear regression, accounting for clustering within patients. RESULTS: The study population included 2210 patients (mean age: 56 years; 54% men). CMA for AED was 91% for patients where the co-payment corresponded to 100% of the price. Compared with these patients, refill adherence for AED was 2-4% higher (P < 0.001) for patients with reduced co-payment (co-payment of ≤50% of the price). Higher age, higher income and fenytoin use were also associated with a higher refill adherence for AED. CONCLUSIONS: Using AED as an example, a higher level of reimbursement was associated with a higher refill adherence compared with full co-payment in Sweden.
BACKGROUND: In the Swedish reimbursement scheme, the co-payment is based on the price of the product and decreases in a stepwise manner as the total accumulated co-payment increases. The aim of this study was to analyse how refill adherence in Sweden varies according to patient's co-payment level for medicines, with antiepileptic drug (AED) use as an example. METHODS: Prevalent AED users aged 18-85 years who purchased an AED between 1 January and 30 June 2007 were identified in the Swedish Prescribed Drug Register and followed for a maximum of 2 years. Patient time was categorized based on patient's accumulated co-payment for all drugs per reimbursement period. The continuous measure of medication acquisition (CMA) was used to estimate refill adherence in relation to the patients' co-payment level. Associations between patients' co-payment for all medicines and refill adherence were assessed with multilevel mixed-effects linear regression, accounting for clustering within patients. RESULTS: The study population included 2210 patients (mean age: 56 years; 54% men). CMA for AED was 91% for patients where the co-payment corresponded to 100% of the price. Compared with these patients, refill adherence for AED was 2-4% higher (P < 0.001) for patients with reduced co-payment (co-payment of ≤50% of the price). Higher age, higher income and fenytoin use were also associated with a higher refill adherence for AED. CONCLUSIONS: Using AED as an example, a higher level of reimbursement was associated with a higher refill adherence compared with full co-payment in Sweden.
Authors: Isabell Brikell; Qi Chen; Ralf Kuja-Halkola; Brian M D'Onofrio; Kelsey K Wiggs; Paul Lichtenstein; Catarina Almqvist; Patrick D Quinn; Zheng Chang; Henrik Larsson Journal: Epilepsia Date: 2019-01-25 Impact factor: 5.864
Authors: Jonas W Wastesson; Johan Fastbom; Gunilla Ringbäck Weitoft; Stefan Fors; Kristina Johnell Journal: Eur J Public Health Date: 2014-05-24 Impact factor: 3.367
Authors: Davide Rasella; Thomas Hone; Luis Eugenio de Souza; Renato Tasca; Sanjay Basu; Christopher Millett Journal: BMC Med Date: 2019-04-26 Impact factor: 8.775