Sticking to a Statin Regimen Pays Off

Patients who take statins as prescribed save health care dollars and have fewer life-threatening complications than nonadherent patients.

Patients know they should take their medications as prescribed. But when faced with unexpected side effects, hefty drug costs, and a lack of obvious symptoms, many find the arguments for adhering less compelling than the reasons to skip a dose or two.

In fact, more than 50% of patients who are treated with statins fall behind on their medications within the first year of treatment. New findings by the Medco Research Institute give these patients concrete evidence that skipping doses isn't the answer.

According to the retrospective cohort analysis, patients who take the cholesterol-lowering medications as prescribed have fewer cardiovascular-related hospitalizations and lower health care costs than those who don't. "Even when the improved adherence rate resulted in higher drug costs, the increase was more than offset by the reduction in medical costs," authors wrote in the June 2011 issue of the American Journal of Cardiology.

Patient education is the key to realizing the potential savings and positive health outcomes of statin adherence, according to Donald Pittman, PharmD, lead study author and National Practice Leader for the Medco Cardiovascular Therapeutic Resource Center. He encourages pharmacists and other health care providers to engage patients in open dialogue about the importance of medication adherence.

“In this study, we found that nearly one in three patients had poor adherence to their statin therapy, something that patients and their physicians can work together to improve, and potentially save the health care system billions of dollars annually,” said Dr. Pittman.

He added that common reasons for nonadherence "are issues we can address" by recommending cost effective alternatives, discussing potential side effects, and identifying behavioral obstacles that could prevent patients from deriving the full benefit of their medications.

The trial analyzed pharmacy claims records of 381,422 adults aged 18 to 61 years who received statin therapy between January 2007 and June 2009. The average age among study participants was 53, and 59% were men. In addition to high cholesterol, 52.1% had hypertension, 25.5% had diabetes, 15.2% had coronary artery disease, and 8.6% had a diagnosis of depression.

Adherence was determined using medication possession ratio (MPR)—a measure of adherence that describes the percentage of time a patient had access to medications based on refill records. Patients were labeled adherent (MPR 80% and higher), moderately adherent (MPR 60%-79%), or nonadherent (59% and below). Although most patients (67%) did adhere to their statin regimens, 32% of participants had adherence rates that were suboptimal.

Patients with the highest level of adherence (MPR 90% and higher) had total health care costs of $10,162, compared with $11,106 for patients who were nonadherent—a difference of $944 over 18 months. Patients in the least adherent group also had "significantly greater odds" of cardiovascular-related hospitalization, according to the results. Across all patient groups, researchers observed an inverse relationship between adherence and health care costs.

For other articles in this issue, see:

• HHS Names 8 New Carcinogens to Avoid
• Preventing Preterm Births with a Flu Shot