Outcome evaluation of a pharmacy-based therapy management program for patients with cystic fibrosis

ObjectiveTo compare medication adherence, pulmonary exacerbations, healthcare utilization, and costs for patients with cystic fibrosis (CF) who utilized a pharmacy-based therapy management program to a matched control group. We hypothesized that patient management services would be associated with better medication adherence, and thus require fewer visits to the emergency room or hospitalizations. MethodsThis retrospective, observational cohort study used claims data from the MORE2 claims Registry (R). The sample consisted of CF patients, aged 6+, who had 1 pharmacy claim for inhaled tobramycin, inhaled aztreonam, ivacaftor, or dornase alfa from 6/2/2014-5/31/2015. Adherence was measured as proportion of days covered (PDC). Propensity score matching and multivariable regression techniques were used to compare outcomes in program participants to matched controls. ResultsOf the 236 intervention and 724 control patients meeting selection criteria, 202 were propensity-matched from each cohort. Relative to the control cohort, program patients had 23% higher mean PDC for tobramycin (IRR=1.23, P=0.01) and were twice as likely to be adherent to tobramycin (PDC80%) than matched controls (OR=2.14, P=0.04). Program patients had fewer ER visits (IRR=0.52, P<0.01) and slightly lower ER costs (IRR=0.66, P=0.06) than the control patients. ConclusionA pharmacy-based therapy management program for CF patients was associated with higher adherence to inhaled tobramycin and lower ER rates. Pharmacies that provide therapy management can support effective CF care management.