Background 

Cost-related medication nonadherence (CRMNA) refers to not taking medications as prescribed because of difficulties paying for them.

Objectives 

The aims of this study were (1) to assess the prevalence of CRMNA to immunosuppressants in heart transplant recipients internationally and (2) to determine multilevel correlates (patient, center, and healthcare system levels) of CRMNA.

Methods 

Using data from the cross-sectional international BRIGHT study, applying multistaged sampling, CRMNA was assessed via 3 self-report items in 1365 patients from 36 heart transplant centers in 11 countries. Cost-related medication nonadherence was defined as any positive answer on any of the 3 items. Healthcare system–level (ie, insurance coverage, out-of-pocket expenditures) and patient-level (ie, intention, perceived financial burden, cost as a barrier, a health belief regarding medication benefits, cost-related self-efficacy, and demographic factors) CRMNA correlates were assessed. Correlates were examined using mixed logistic regression analysis.

Results 

Across all study countries, CRMNA had an average prevalence of 2.6% (range, 0% [Switzerland/Brazil] to 9.8% [Australia]) and was positively related to being single (odds ratio, 2.29; 95% confidence interval, 1.17–4.47), perceived financial burden (odds ratio, 2.15; 95% confidence interval, 1.55–2.99), and cost as a barrier (odds ratio, 2.60; 95% confidence interval, 1.66–4.07). Four protective factors were identified: white ethnicity (odds ratio, 0.37; 95% confidence interval, 0.19–0.74), intention to adhere (odds ratio, 0.44; 95% confidence interval, 0.31–0.63), self-efficacy (odds ratio, 0.54; 95% confidence interval, 0.43–0.67), and belief about medication benefit (odds ratio, 0.70; 95% confidence interval, 0.57–0.87). Regarding variability, 81.3% was explained at the patient level; 13.8%, at the center level; and 4.8%, at the country level.

Conclusion 

In heart transplant recipients, the CRMNA prevalence varies across countries but is lower than in other chronically ill populations. Identified patient-level correlates are novel (ie, intention to adhere, cost-related barriers, and cost-related self-efficacy) and indicate patient-perceived medication cost burden.

中文翻译：

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心脏移植后免疫抑制药物的成本相关药物不依从性的流行率和相关性：国际多中心横断面 Bright 研究。

背景 

与成本相关的药物不依从 (CRMNA) 是指由于支付困难而未按规定服用药物。

目标 

本研究的目的是 (1) 评估 CRMNA 在国际心脏移植受者中对免疫抑制剂的流行率，以及 (2) 确定CRMNA 的多级相关性（患者、中心和医疗保健系统级别）。

方法 

使用来自横断面国际 BRIGHT 研究的数据，应用多阶段抽样，通过 3 个自我报告项目对来自 11 个国家的 36 个心脏移植中心的 1365 名患者进行了 CRMNA 评估。成本相关的药物不依从被定义为对 3 个项目中的任何一个的任何肯定回答。医疗保健系统层面（即保险范围、自付费用）和患者层面（即意图、感知的财务负担、成本作为障碍、关于药物益处的健康信念、与成本相关的自我效能感，以及人口统计学因素）评估了 CRMNA 相关性。使用混合逻辑回归分析检查相关性。

结果 

在所有研究国家中，CRMNA 的平均患病率为 2.6%（范围，0% [瑞士/巴西] 至 9.8% [澳大利亚]）并且与单身呈正相关（优势比，2.29；95% 置信区间，1.17– 4.47)、感知财务负担（优势比，2.15；95% 置信区间，1.55-2.99），以及作为障碍的成本（优势比，2.60；95% 置信区间，1.66-4.07）。确定了四个保护因素：白人种族（优势比，0.37；95% 置信区间，0.19-0.74），坚持意愿（优势比，0.44；95% 置信区间，0.31-0.63），自我效能（优势比， 0.54；95% 置信区间，0.43–0.67），以及对药物益处的信念（优势比，0.70；95% 置信区间，0.57–0.87）。关于变异性，81.3% 是在患者层面解释的；13.8%，处于中心水平；4.8%，在国家层面。

结论 

在心脏移植受者中，CRMNA 患病率因国家而异，但低于其他慢性病人群。确定的患者水平相关性是新颖的（即，坚持的意愿、与成本相关的障碍和与成本相关的自我效能）并表明患者感知的药物成本负担。