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Is There a Relationship between Early Statin Compliance and a Reduction in Healthcare Utilization?

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Compliance with statin therapy in the first two years of use may reduce hospitalization rates and direct medical costs in the subsequent year.

This article originally appeared in the June 2010 issue of the American Journal of Managed Care, part of the HCPLive network.

An estimated 16 million Americans have coronary heart disease (CHD). It is the most common cause of mortality among American adults. Because of the morbidity and mortality burden of CHD, it is not surprising that costs associated with this condition are high. In the United States in 2008, direct medical costs for CHD exceeded $87 billion, while indirect costs (lost productivity of the patient and the caregiver) accounted for an additional $70 billion. Therefore, identifying strategies for reducing the incidence of CHD can lead to significant monetary savings.

One proven strategy for prevention of CHD is to reduce low-density lipoprotein cholesterol (LDL-C) levels. A considerable body of evidence demonstrates that hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins) are effective and well-tolerated agents for decreasing LDL-C levels and for reducing cardiovascular (CV) events.

However, treatment can be expected to provide a clinical benefit only in patients who take their medication continuously on a long-term basis. Several studies have demonstrated that LDL-C level and CV risk reduction with lipid-lowering therapy is greater in patients who are compliant with therapy and that poor compliance may account for the difference in outcomes between randomized controlled trials and clinical practice. Data are limited about the effect of compliance on outcomes within the first 1 to 2 years of treatment with statins. Veterans Healthcare Administration data indicate that compliance during the first 1 to 2 years of statin treatment can reduce mortality in the subsequent year among patients with diabetes. However, that study was conducted in a high-risk population, and it is unknown whether early compliance with statin therapy can provide tangible benefits in terms of healthcare resource utilization among a more heterogeneous population.

The objective of the present study was to evaluate the effect of statin therapy compliance during the first two years of treatment on healthcare resource utilization in year three from the payer perspective. We hypothesized that patients with continuous statin treatment compliance will incur lower healthcare costs in the following year than patients with less compliance, even in early stages of treatment.

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