Adherence to Statins, Subsequent Healthcare Costs, and Cardiovascular Hospitalizations

Mar 31, 2011
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Authors:
Pittman DG, Chen W, Bowlin SJ, Foody JM.
Citation:
Am J Cardiol 2011;Mar 23:[Epub ahead of print].
Summary By:
Melvyn Rubenfire, MD, FACC

Study Questions:

What is the affect of statin adherence on health care costs?

Methods:

The authors evaluated the relationship between statin adherence, subsequent hospitalizations, and health care costs, in a retrospective cohort study of 381,422 patients, ages 18-61 years, using an integrated pharmacy and medical claims database. Adherence was assessed using the medication possession ratio (MPR) for 12 months, and the health care costs and cardiovascular disease-related hospitalizations during the subsequent 18 months.

Results:

Of those studied, 258,013 (67.6%) were adherent (MPR >80%), 65,795 (17.3%) had an MPR of 60-79%, and 57,614 (15.1%) had an MPR of <60%. The adjusted all-cause total health care costs were lowest in the adherent group at $10,198 ± $39.4 (mean ± standard error) versus $10,609 ± $77.7 (p < 0.001) for an MPR of 60-79%, and $11,102 ± $84.3 (p < 0.001) for an MPR of <60%. The adherent group had greater statin costs at $838 ± $1.0 versus $664 ± $2.0 (p < 0.001) and $488 ± $2.2 (p < 0.001). When evaluated by five levels of MPR, 0-59% and increments of 10% to >60%, the adjusted total health care costs were lowest for the MPR 90-100% group and significantly greater statistically (p < 0.001) for each lower level of adherence. Nonadherence was associated with a $400-$900 per patient greater total health care cost, and increased the likelihood of a cardiovascular disease–related hospitalization in the subsequent 18 months.

Conclusions:

In conclusion, statin adherence is associated with reductions in subsequent total health care costs and cardiovascular disease–related hospitalizations.

Perspective:

Experience is that statin no adherence (also known as persistence) post–acute coronary syndrome is more related to lack of patient understanding of the drug’s purpose and safety and inadequate prescription refills than cost. As the authors contend, practitioners should vigilantly look for poor adherence at every contact. It is particularly important that discharge instructions be clear and prescriptions be written with adequate supply and refills.

Keywords: Acute Coronary Syndrome, Cardiology, Health Care Costs, Hospitalization


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