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Peer-reviewedCC BY-NC 4.0British Journal of Clinical Pharmacology

Standardization of measurement and reporting of medication adherence using the TEN‐SPIDERS tool for claims data

  • Adam C. Livori1,2,3
  • Tzu‐Yung Kuo4,5
  • Jenni Ilomäki1
  • Monique F. Kilkenny4,5
  • Stella Talic6
  • Zanfina Ademi1,6
  • J. Simon Bell1
  • Jedidiah I. Morton3,6
  • Lachlan L. Dalli4,5
6 affiliations
  1. 1Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical, Sciences Monash University Melbourne Victoria Australia
  2. 2Pharmacy Department Grampians Health Ballarat Victoria Australia
  3. 3Clinical Diabetes and Epidemiology Baker Heart and Diabetes Institute Melbourne Victoria Australia
  4. 4Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences Monash University Melbourne Victoria Australia
  5. 5Victorian Heart Institute Monash University Clayton Victoria Australia
  6. 6School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
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Abstract

Aim: The TEN‐SPIDERS framework provides a structured approach to calculating and reporting the proportion of days covered (PDC) in medication adherence research, but gaps remain in operationalizing this framework into statistical code. We aimed to develop an open‐source tool to standardize PDC calculation against parameters of the TEN‐SPIDERS reporting framework.

Methods: Phase 1 involved developing the Stata statistical tool to enable flexible adjustment of TEN‐SPIDERS PDC parameters: threshold, eligibility, numerator, in‐hospital stays, dose imputation, early refills and survival. The tool was developed to align with established data definitions, variable schemas and person‐level record structures in linked Australian Pharmaceutical Benefits Scheme (PBS) datasets, with scope for interoperability across similar international systems. In Phase 2, PDC was estimated in a linked PBS dataset for survivors of myocardial infarction (37 919 statin users and 29 163 P2Y12 inhibitor users). The impact of different TEN‐SPIDERS adjustments was evaluated against basic settings and a pre‐existing Stata package (MedAdhere).

Results: The TEN‐SPIDERS tool was developed to support reproducible PDC calculations. While computation time was similar to the pre‐existing MedAdhere package (116.5 vs. 100.2 s), the TEN‐SPIDERS tool had greater flexibility to incorporate adjustments for different medication‐taking situations. A bivariate comparison between different settings of TEN‐SPIDERS highlighted a strong correlation (Pearson's r: >.9) with MedAdhere, with additional adjustments reducing Pearson's correlation from .987 to .921.

Conclusion: The TEN‐SPIDERS tool provides a transparent, reproducible and efficient open‐source method for medication adherence research within Australia, with potential applicability to similarly structured international datasets. Adoption of this tool will support global efforts for standardization in medication adherence research.

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Cite

BibTeXRIS
BibTeX
@article{livori2026standardization,
  title = {{Standardization of measurement and reporting of medication adherence using the TEN‐SPIDERS tool for claims data}},
  author = {Adam C. Livori and Tzu‐Yung Kuo and Jenni Ilomäki and Monique F. Kilkenny and Stella Talic and Zanfina Ademi and J. Simon Bell and Jedidiah I. Morton and Lachlan L. Dalli},
  journal = {British Journal of Clinical Pharmacology},
  year = {2026},
  month = jul,
  doi = {10.1002/bcp.70646},
  url = {https://doi.org/10.1002/bcp.70646},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Standardization of measurement and reporting of medication adherence using the TEN‐SPIDERS tool for claims data
AU  - Adam C. Livori
AU  - Tzu‐Yung Kuo
AU  - Jenni Ilomäki
AU  - Monique F. Kilkenny
AU  - Stella Talic
AU  - Zanfina Ademi
AU  - J. Simon Bell
AU  - Jedidiah I. Morton
AU  - Lachlan L. Dalli
PY  - 2026
DA  - 2026/07/06
JO  - British Journal of Clinical Pharmacology
DO  - 10.1002/bcp.70646
UR  - https://doi.org/10.1002/bcp.70646
AB  - Aim: The TEN‐SPIDERS framework provides a structured approach to calculating and reporting the proportion of days covered (PDC) in medication adherence research, but gaps remain in operationalizing this framework into statistical code. We aimed to develop an open‐source tool to standardize PDC calculation against parameters of the TEN‐SPIDERS reporting framework.  Methods: Phase 1 involved developing the Stata statistical tool to enable flexible adjustment of TEN‐SPIDERS PDC parameters: threshold, eligibility, numerator, in‐hospital stays, dose imputation, early refills and survival. The tool was developed to align with established data definitions, variable schemas and person‐level record structures in linked Australian Pharmaceutical Benefits Scheme (PBS) datasets, with scope for interoperability across similar international systems. In Phase 2, PDC was estimated in a linked PBS dataset for survivors of myocardial infarction (37 919 statin users and 29 163 P2Y12 inhibitor users). The impact of different TEN‐SPIDERS adjustments was evaluated against basic settings and a pre‐existing Stata package (MedAdhere).  Results: The TEN‐SPIDERS tool was developed to support reproducible PDC calculations. While computation time was similar to the pre‐existing MedAdhere package (116.5 vs. 100.2 s), the TEN‐SPIDERS tool had greater flexibility to incorporate adjustments for different medication‐taking situations. A bivariate comparison between different settings of TEN‐SPIDERS highlighted a strong correlation (Pearson's r: >.9) with MedAdhere, with additional adjustments reducing Pearson's correlation from .987 to .921.  Conclusion: The TEN‐SPIDERS tool provides a transparent, reproducible and efficient open‐source method for medication adherence research within Australia, with potential applicability to similarly structured international datasets. Adoption of this tool will support global efforts for standardization in medication adherence research.
SN  - 0306-5251
SN  - 1365-2125
ER  -