| Background. Vaginal atrophy, or atrophic vaginitis, is a symptom of menopause experienced by up to 40% to 50% of postmenopausal women. Symptoms include vaginal dryness, itching, and irritation; dyspareunia; successive urinary tract infections; and urinary incontinence. The most effective therapy for atrophic vaginitis is vaginal estrogen, available in cream and tablet forms. Not all forms have received equal acceptance, potentially resulting in sub-optimal medication adherence and persistence. The objective of this study was to understand the medication-taking behavior of vaginal estrogen users in clinical practice and measure associated healthcare utilization and cost outcomes.;Methods. Retrospective claims of women enrolled in the North Carolina Medicaid program between January 2003 and December 2007 were analyzed. Inclusion criteria were occurrence of at least one prescription claim for vaginal estrogen and continuous health plan enrollment for 12 months prior to and 12 months following vaginal estrogen initiation. Multivariate regression analyses were used to estimate the effect of form of vaginal estrogen on medication adherence, medication persistence, and health services utilization and cost outcomes. Adherence was measured using the medication possession ratio (MPR); persistence was measured using treatment duration. Additional outcomes explored included prescribing provider specialty, proportion of initial prescriptions refilled, and switching to the other form of vaginal estrogen. Covariates included age, race, Charlson Comorbidity Index, mammography, prior and current use of systemic estrogen, and the number of outpatient office visits in the year prior to vaginal estrogen initiation.;Results. 1,505 women (30% black, age 40--64 years, mean age 53.2 years) met all inclusion criteria. 89.6% of women used vaginal cream products; 10.4% used vaginal tablets. An estimated 23.3% of vaginal estrogen prescriptions were prescribed by obstetrician/gynecologists. Mean MPR was 0.31 for vaginal tablet users; 0.27 for vaginal cream users (p = 0.117). Treatment duration over two years of follow-up was similar for both forms of vaginal estrogen (296 days for vaginal tablets vs. 280 days for vaginal cream, p = 0.607). Tablet users refilled their first prescription at a significantly higher rate (48.8% for vaginal tablets, 35.3% for vaginal cream, p = 0.001) but more often switched to the other form of vaginal estrogen (4.4% vs. 1.7%, p = 0.023). Annual obstetrician/gynecologist and primary care physician costs and vaginal estrogen prescription costs for tablets and creams were similar. Multivariate regression models suggest that use of vaginal tablets compared to vaginal creams is significantly associated with more often refilling the initial prescription (odds ratio 1.77, p = 0.001), higher number of annual vaginal estrogen prescriptions (beta = 0.322, p < 0.001), and lower vaginal estrogen prescription costs (beta = -0.133, p = 0.019).;Conclusion. Women on vaginal tablet therapy were more likely to refill their initial prescription and, although not significant over a 2 year window, to have longer treatment duration, indicating a preference for this treatment modality. At the same time, healthcare utilization in terms of physician visits and costs were no higher for vaginal tablet users than vaginal cream users, and were significantly lower in vaginal estrogen prescription costs. |
