Lack of adherence to lipid‐lowering drug treatment. A comparison of utilization patterns in defined populations in Funen, Denmark and Bologna, Italy

Abstract

Aims The objective was to explore differences in lipid‐lowering drug (LLD) prescribing in Italy and Denmark. Methods We used two geographical areas with computerized drug prescription records in defined populations, one in Funen, Denmark with 500 000 inhabitants, the other in Bologna, Italy with 400 000 inhabitants. Prescriptions for patients who had purchased a LLD from 1994 until 1996 were retrieved as well as coprescriptions of antidiabetic and cardiovascular drugs as markers for diabetes and cardiovascular disease. Only patients surviving and remaining in the area were included. Compliance was defined as percentage of DDDs purchased divided by the number of days within the time window. The limit between good and poor compliance was set at 82%. Results In Bologna, LLD consumption measured in DDD increased by 41% and in Funen by 129%. Annual prevalence increased from 36.9 to 46.3 users/1000 inhabitants from 1994 to 1996 and from 3.2 to 6.6 users/1000 inhabitants in Bologna and Funen, respectively. From 1995 to 1996, the incidence of use decreased slightly in Bologna from 19.3 to 18.8/1000 inhabitants/year, whereas in Funen the incidence increased from 1.8 to 2.3/1000 inhabitants/year. In Bologna 48% and in Funen 91% of users persisted with treatment for 2 years or longer. In Bologna, 7% and in Funen 45% were good compliers. In Bologna, 61% and in Funen, 72% received other drugs indicating cardiovascular or diabetic comorbidity. Conclusions Patterns of use differed substantially between the two areas. In contrast with Funen, where long‐term use was common, Bologna LLD use was sporadic. Based on a higher rate of coprescription, LLDs seemed to be used for secondary prevention to a higher extent in Funen than in Bologna. In Funen it appeared that the correct patients, but an insufficient number of them, were being treated adequately according to guidelines. The higher discontinuation rate of lipid lowering drugs in the Bologna area indicates that a large proportion of patients use these drugs for too short a period of time to benefit from treatment. Since society’s health care resources are limited it is difficult to justify public funding of these medications without at the same time giving appropriate attention to these problems.

Agreement between self-reported data on medicine use and prescription records vary according to method of analysis and therapeutic group

“…However, PDD would be closer to actual use than assuming a medicine use of one DDD per day, as some DDDs are doses rarely prescribed and medicines are often used for various indications [16]. As suggested elsewhere, for statins, a more relevant measure of daily dose for some therapeutic regimes might be one tablet, as tablets come in different strengths [29].…”

Variations and increase in use of statins across Europe: data from administrative databases

“…We must consider other explanations, and these may lie in factors unique to each country: for example, differences between Norway and Denmark may reflect the involvement of Norwegian doctors in seminal trials, while in Denmark these drugs were only reimbursed from 1998 onwards and their use has lagged behind other countries. Low use in Italy may reflect low coronary morbidity or poor adherence of Italian patients to statins, worse than elsewhere in Europe 4. Other differences may lie in national guidance and policies.…”

Guidelines accompanied by changes in reimbursement rules Effects on lipid-lowering drug prescribing

“…In 1996, Danish cardiologists estimated that the prevalence of patients who needed LLDs was 5% of the total population (6). We found that in the year following the issue of guidelines, about 1% of all individuals B65 years and 4% of all individuals ]65 years were treated with LLDs.…”

“…However, studies from a number of different European countries show that patients with an increased risk of CHD are not offered optimal prevention (5). Particularly, a substantial under-use of lipid-lowering drugs (LLDs) has come to attention (5,6).…”