gout fix plan Tag

As part of my research into this thorny issue, I was reminded of some comprehensive research into gout drug utilization. I have referred to this previously in a newsletter, so it’s high time I summarized this research as part of my forthcoming review of gout treatment compliance.

Gout Drug Utilization Research

This research was reported at the 2006 Annual Scientific Meeting of the American College of Rheumatology (ACR). I have paraphrased some of the language to avoid some jargon, though it is inevitable that some scientific terminology is required in this type of report.

Gout Drug Utilization Research Title

Retrospective Claims Analysis of Gout Drug Utilization, Compliance and Associated Serum Urate Levels [1]

Gout Drug Utilization Research Authors

R. Halpern; K.G. Saag; R.R. Mody; T.R. Mikuls; P.A. Patel

Gout Drug Utilization Research Abstract

PURPOSE:

Gout affected an estimated 8.4/1,000 people in 2002. Our objectives were to:

• Estimate the prevalence of gout in one of the largest US health plans;
• Examine drug therapy utilization;
• Determine the association of allopurinol compliance with serum uric acid (sUA) level.

METHODS:

We used medical, pharmacy, and laboratory claims data from a large, geographically diverse health plan (approximately 13 million lives) with commercial, Medicare, and Medicaid coverage. Gout patients were identified according to medical claims:

• 2 or more medical claims with a gout diagnosis (274.xx) on separate dates or
• 1 or more prescription claim for allopurinol, probenecid, colchicine, or sulfinpyrazone between 1/1/02 and 3/31/04;

The first relevant claim provided the “index date.” Claims were examined for 1 year before and after that index date.

Compliance was measured as medication possession ratio (MPR: days supply of drug from first fill through follow-up/days from first fill through follow-up, range 0-1). So if a claim for 30 days of allopurinol were followed by a 50 day gap before the second claim, then MPR = 30/50 = 0.6.

RESULTS:

25,226 gout patients were identified based on our selection criteria: 11,660 (46%) by prescription; 4,895 (19%) via diagnoses; 8,671 (35%) met both criteria. The mean (standard deviation (SD)) age was 54.6 (13.5) years. 82% of the study population was male.

Many gout patients suffered other health problems, known as co-morbidities. Prevalent co-morbidities were:

• Hypertension, high blood pressure, (affecting 49% of the population)
• Hyperlipidemia, high cholesterol, (41%)

4,901 (approx 19% – slightly less than 1 in 5) of gout patients had 1 or more sUA lab result during baseline or follow-up. The study reports that the average sUA level was 7.6 mg/dL (0.45 mmol/L), though this is largely meaningless, as it does not consider the effects of uric acid lowering drugs. Gout prevalence in the health plan population between 1/1/02 and 3/31/04 was 9.25/1,000. Prevalence was higher among men and increased with age.

60% of gout patients filled 1 or more allopurinol prescription during the 2-year study period, making it the most commonly prescribed gout drug therapy. Nearly 31% filled 1 or more colchicine prescription, followed by probenecid (3.1%), probenecid/colchicine (2.2%), and sulfinpyrazone (0.1%). About 16% used 2 or more gout drugs during the study period; most common were allopurinol and colchicine.

Average MPRs were: 0.64 for allopurinol; 0.23 for colchicine; 0.50 for probenecid; 0.41 for probenecid/colchicine; and 0.41 for sulfinpyrazone.

2,941 patients had an sUA result and at least 1 allopurinol prescription. These allopurinol patients 41% were “compliant” (MPR at least 0.8); however, only 35% of compliant patients had sUA below 6.0 mg/dL (0.36 mmol/L).

CONCLUSION:

The prevalence of gout in this health plan population is consistent with previous estimates. A high proportion had other chronic health conditions.

Although allopurinol was the most commonly prescribed drug for gout management, non-compliance with this agent was frequent. Moreover, a large proportion of patients compliant with allopurinol did not achieve target sUA level below 6.0 mg/dL, suggesting room for improvement in the current management of gout and gout medication compliance.

Gout Drug Utilization Summary

The accepted long term treatment of gout (a gout fix plan) is:

1. Take allopurinol (or other uric acid lowering treatment) everyday
2. Test uric acid in the blood at least once a month to establish the right dose
3. Be prepared to take pain relief in addition for a few months, as required or as a daily preventative.
4. Review treatment every 6 months to one year

If your doctor advises this, then follow this advice. If your doctor does not advise it, then either insist on this treatment, or seek another doctor. If any part of this is unclear, then discuss it in the gout forum.

Gout Drug Utilization References

1. AUTHORNAME. Retrospective Claims Analysis of Gout Drug Utilization, Compliance and Associated Serum Urate Levels . . 2011-01-20. URL:http://acr.confex.com/acr/2006/webprogram/Paper4307.html. Accessed: 2011-01-20. (Archived by WebCite® at http://www.webcitation.org/5vsWdew4k)

Do not start with the herbal mixture, and explain how you are sort-of-cured, but not quite.

Do not start with the allopurinol itch, and explain how your gout would be fixed if only you took the meds every day.

Do not hide behind food obsessions, and explain how gout never troubles you if you can only avoid purines.

Get a plan, and focus on fixing your gout. Let me help you focus on G.O.U.T.

The ⒼⓄⓊⓉ Plan To Fix Gout

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