Long-term persistence with statin treatment in a not-for-profit health maintenance organization: A population-based retrospective cohort study in Israel

Chodick, Gabriel; Shalev, Varda; Gerber, Yariv; Heymann, Anthony; Silber, Haim; Simah, Virginia; Kokia, Ehud

doi:10.1016/j.clinthera.2008.11.012

Cited by 138 publications

(135 citation statements)

References 43 publications

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“…[5][6][7][8][9] Several studies also reported suboptimal short-term adherence to statins, within 1 year of treatment initiation. [9][10][11][12][13][14] Their effectiveness could be compromised in actual practice when patients are not adherent to the treatments.…”

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confidence: 99%

Moving Branded Statins to Lowest Copay Tier Improves Patient Adherence

Chen¹,

Shah²,

Lee³

et al. 2014

JMCP

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BACKGROUND: Statins are efficacious in reducing the risk of major cardiovascular events for both primary and secondary prevention, yet long-term adherence is poor. Their effectiveness could be compromised in actual practice when patients are not adherent to the treatments. Higher copayments have been shown to be associated with lower adherence to statins. OBJECTIVE: To assess the effect on patient adherence of moving branded atorvastatin and rosuvastatin from the second to the first tier by a Medicare Part D plan sponsor.METHODS: Pharmacy claims and eligibility records between July 1, 2009, and July 31, 2011, of Medicare Part D members not receiving the lowincome subsidy were analyzed. New atorvastatin and rosuvastatin users in January 2010 (2010 cohort) were compared with those in January 2011 (2011 cohort) after this formulary tier change (tier-reduction group). Adherence was defined by the proportion of days covered (PDC) over 6 months. The impact of tier reduction on adherence was evaluated via logistic regression for binary outcome (PDC≥0.8) and generalized linear regression for continuous PDC by comparing the 2011 cohort with the 2010 cohort, adjusting for demographic and clinical characteristics. Other statin users (97% on generic statins) were also analyzed, serving as a nontierreduction comparator group. RESULTS: We identified 12,437 members in the tier-reduction group. Between the 2010 and 2011 cohorts, mean PDC increased from 0.77 to 0.83, and the proportion of members with high adherence increased from 62.0% to 72.9% (both P < 0.001). After regression adjustment, members in the 2011 cohort were more likely to be adherent (OR=1.68; 95% CI=1.55-1.82) and had a 5.9% increase in PDC (P < 0.05). There was no significant increase in adherence observed in the comparator nontier-reduction group. CONCLUSION: Findings from this study suggest that financial incentives may improve medication adherence. Future studies should evaluate whether such formulary strategies improve long-term adherence and patient outcomes.

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Moving Branded Statins to Lowest Copay Tier Improves Patient Adherence

Chen¹,

Shah²,

Lee³

et al. 2014

JMCP

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“…For example, in testing various models to predict adherence among 14,257 commercially insured patients initiating statin treatment, Chan et al (2010) found that a model containing copayment data without other covariates produced a c-statistic of 0.543, 53 (where 0.50 indicates predictive ability equivalent to random assignment and 1.00 indicates perfect prediction), 54 suggesting that copayment information gives one no better chance than a coin toss of predicting adherence behavior. In a study of 229,918 adult enrollees in an Israeli health maintenance organization, Chodick et al (2008) found that 75% or more of patients in both primary and secondary prevention discontinued statin treatment within 2 years after treatment initiation despite "low out-of-pocket prescription costs and free access to health services." 55 Analyses of interaction terms in Post-MI FREEE found that the relationship between the intervention and the primary endpoint outcome did not significantly vary by the baseline (pre-intervention)…”

Section: Modest Adherence Improvements In Post-mi Freee Are Consistenmentioning

confidence: 99%

VBID, the PPACA, and FREEE Medications: Did Politics Trump the Evidence About Cost Sharing?

Fairman¹,

Curtiss²

2012

JMCP

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“…In a retrospective cohort study from Israel, up to 75% of the 229,918 patients enrolled discontinued statin therapy within 2 years of its start. 5 In another report, the main reason for discontinuation of statin therapy was the onset of side effects.…”

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Statin-related myotoxicity

Fernandes

Santos

Pérez

2016

Endocrinología y Nutrición

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Statin therapy has a very important role in decreasing cardiovascular risk, and treatment non-compliance may therefore be a concern in high cardiovascular risk patients. Myotoxicity is a frequent side effect of statin therapy and one of the main causes of statin discontinuation, which limits effective treatment of patients at risk of or with cardiovascular disease. Because of the high proportion of patients on statin treatment and the frequency of statinrelated myotoxicity, this is a subject of concern in clinical practice. However, statin-related myotoxicity is probably underestimated because there is not a gold standard definition, and its diagnosis is challenging. Moreover, information about pathophysiology and optimal therapeutic options is scarce. Therefore, this paper reviews the knowledge about the definition, pathophysiology and predisposing conditions, diagnosis and management of statin-related myotoxicity, and provides a practical scheme for its management in clinical practice. © 2016 SEEN. Published by Elsevier España, S.L.U. All rights reserved. PALABRAS CLAVEEstatinas; Inhibidores de la HMG-CoA reductasa; Efectos secundarios a fármacos; Intolerancia a estatinas; Miotoxicidad; Miopatía Miotoxicidad por estatinasResumen El tratamiento con estatinas tiene un papel fundamental en la reducción del riesgo cardiovascular, y la falta de adherencia al mismo es motivo de preocupación en los pacientes con alto riesgo. La miotoxicidad es un efecto secundario frecuente y una de las principales causas de interrupción de las estatinas, lo que limita el tratamiento eficaz de los pacientes con riesgo de enfermedad cardiovascular. Considerando la elevada proporción de pacientes en tratamiento con estatinas, y la frecuencia de miotoxicidad asociada, este es un tema relevante en la práctica clínica. Sin embargo, la miotoxicidad por las estatinas está probablemente subestimada debido a que no hay una definición bien establecida y su diagnóstico resulta difícil. * Corresponding author. E-mail address: aperez@santpau.cat (A. Pérez). 1 The first two authors contributed equally to this work. þÿ D e s c a r g a d o d e C l i n i c a l K e y . e s d e s d e F u n d a c i ó d e G e s t i ó S a n i t à r i a d e l H o s p i t a l d e S a n t a C r e u i S a n t P a u m a y o 0 8 , 2 0 1 6 . Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2016. Elsevier Inc. Todos los derechos reservados. V. Fernandes et al.Además, la información sobre la fisiopatología y las opciones terapéuticas óptimas es escasa. En este artículo revisamos la definición, fisiopatología y condiciones predisponentes, diagnóstico y tratamiento de la miotoxicidad por las estatinas, y proponemos un esquema práctico para su manejo.

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Long-term persistence with statin treatment in a not-for-profit health maintenance organization: A population-based retrospective cohort study in Israel

Cited by 138 publications

References 43 publications

Moving Branded Statins to Lowest Copay Tier Improves Patient Adherence

Moving Branded Statins to Lowest Copay Tier Improves Patient Adherence

VBID, the PPACA, and FREEE Medications: Did Politics Trump the Evidence About Cost Sharing?

Statin-related myotoxicity

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