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WITHDRAWN: Persistence and Adherence with Urinary Antispasmodic Medications among Employees and the Impact of Adherence on Costs, Absenteeism, and Worker Productivity

Amy Atkinson, HCMS 
Chieh-I (JE) Chen, Pfizer Inc 
Nathan Kleinman, HCMS 
Kevin Odell, Pfizer Inc 
Kelly Zou, Pfizer 

Keywords: adherence, persistence, medications, OAB, UUI, employees, employer

Overactive bladder (OAB) and related conditions, such as urge urinary incontinence (UI), can interfere with work, leisure activities, and healthy sleep patterns. This study aimed to evaluate employee urinary antispasmodic (UA) medication persistence and adherence, the impact of salary and copay on adherence, and the impact of UA medication adherence on medical costs, pharmacy costs, sick leave (SL), short- and long-term disability (STD, LTD) costs, workers’ compensation costs, work absence days, turnover, and worker productivity.

This study used a retrospective 2001-2011 claims, payroll, and demographic database from 27 large US employers. Employees ages 18-64 with prescription claims for UA medications and health plan enrollment from 6 months prior to the index prescription to 12 months after were included. Persistence (days until first >=30-day gap in UA supply) and adherence (percent of days of the post-index period with medication coverage (PDC)) were assessed using survival analysis and generalized linear regression models that controlled for demographics, job-related factors, copay, and pre-index employee benefit utilization.

N=2,960 employees met the study criteria. Median persistence days by OAB-subtype were 76, 82, 43, 66, and 60 for urge UI, mixed UI, nocturnal UI, other OAB, and no diagnosis, respectively (P<0.05 for urge and mixed vs. no diagnosis). Increased copay and increased copay as a percent of annual salary were associated with lower adherence. Employees with >=80% adherence had significantly lower medical, SL, STD, and higher overall drug costs than employees with <80% adherence. In a small subset of employees with available work output data (N=20), greater adherence corresponded to greater annual work productivity output (P=0.0273). These findings suggest potential economic benefits to employers from increased UA adherence, possibly including increased productivity. Additionally, economic factors such as ability to pay influence adherence to UA medications.