IMPACT OF PATIENT DEMOGRAPHICS, CLINICAL CHARACTERISTICS, AND SOCIAL DETERMINANTS OF HEALTH ON ADVANCED THERAPY MEDICATION ADHERENCE AND PERSISTENCE IN ULCERATIVE COLITIS ACROSS UNITED STATES PAYER TYPES
Authors: Ullman Thomas , Hur Peter , Shelbya Ahmed , Buckley Merrion , Gillen Emily , Donthi Shruthi , Gaulthier Genevieve , Balgobin Courtney 
Published: January 2024

Abstract

INTRODUCTION
Social determinants of health (SDOH) factors such as insurance status, race, ethnicity, and socioeconomic status have been associated with clinical outcomes in ulcerative colitis (UC). We assessed the impact of demographic, clinical, and SDOH factors on advanced therapy medication adherence and persistence in patients (pts) with UC.

METHODS
Pts with UC who initiated an advanced therapy (Janus kinase inhibitor, sphingosine-1-phosphate receptor agonist, or biologic) were identified using Commercial and Medicaid Managed Care (MMC) claims data from the MORE2 Registry (2017–2022) and Medicare Fee-for-Service (FFS) (2017–2021) claims. Community-level SDOH variables were linked using pt ZIP codes at index date (first advanced UC therapy prescription date from May 01, 2018 up to Jun 30, 2021). Adherence (proportion of days covered [PDC]) and persistence (duration) of treatment were assessed for 1 year post-index. Logistic regression analyses evaluated the associations between demographic, clinical, and SDOH factors and adherence/persistence.

RESULTS
The number of pts included in the Medicare FFS, Commercial, and MMC plan types were 9,158, 6,706, and 3,170, respectively. Mean PDC were 69%, 72%, and 64% (Fig. a), respectively, and the corresponding proportions of pts with 1-year persistence were 53%, 43%, and 31%, respectively (Fig. b). PDC by percentile is shown in Fig. c. Female pts had lower odds of adherence vs male pts in the Medicare FFS plan only (odds ratio [OR] 0.89; Table). A higher Charlson Comorbidity Index Score was associated with lower odds of adherence in the Medicare FFS and Commercial plans only (OR for both: 0.94; Table). In the 1 year post-index period, a corticosteroid prescription was associated with lower odds of adherence across plan types (OR 0.57–0.66; Table); a 5-aminosalicylic acid prescription was associated with higher odds of adherence in the Medicare FFS and Commercial plans only (OR 1.12–1.15; Table). A mental health condition diagnosis in the 1 year prior to and post-index was associated with lower adherence vs those without among pts with Medicare FFS and Commercial coverage (OR 0.85–0.87; Table). Community-level SDOH variables assessed had no association with adherence (Table); persistence model results were similar (data not shown).

CONCLUSION
For pts initiating an advanced therapy, there are still unmet treatment needs as demonstrated by mean PDC &lt;80% and full persistence ≤53% across plan types. Adherence and persistence were lower among pts on MMC vs Medicare FFS or Commercial plans. The impact of demographic variables on adherence varied depending on plan type. Higher comorbidity burden, mental health diagnosis, and concomitant steroid use were generally associated with lower adherence to advanced UC therapies. Community-level SDOH variables were not associated with adherence in these populations.