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The higher the co-pay, the lower the adherence. Many patients do not take HMG-CoA reductase inhibitors (statins) as directed by their physician or they discontinue them altogether, suggest the results of a new study. This is true even among patients prescribed statins for secondary prevention. The study also suggests that the higher the co-pay, the lower the adherence.
Study chief Dr. Jeffrey J. Ellis from the Cleveland Clinic in Ohio said that, “Suboptimal statin adherence and discontinuation "limits the proven benefit of these drugs and increases healthcare dollars in the long-term through new or recurrent cardiac events – events that are far more costly to treat than they are to prevent."
The initial objective of the study was to see if there was a difference in non-adherence and discontinuation in primary prevention patients (n = 2,544) versus secondary prevention patients (n = 2,258) who are at higher risk for cardiac events.
Dr. Ellis stated that, "To our surprise, we found that both groups were equally and suboptimally non-adherent to statin therapy, with both groups having enough medication on hand to cover only 1 out of every 5 days on average." “We assumed that secondary prevention patients – who have experienced the realities of cardiovascular disease through an MI or cardiac surgery – would have greater levels of day-to-day adherence.”
In terms of discontinuation, the researchers did find that secondary prevention patients had a somewhat greater level of retention.
The most impressive predictor of non-adherence and discontinuation was the level of monthly statin prescription copayment. Patients who paid more than $20 on average per month were four times more likely to discontinue statin therapy compared to those who paid less than $10.
Reporting their work in the June issue of the Journal of General Internal Medicine, the investigators suggest that "incremental efforts, including those that decrease out-of-pocket pharmaceutical expenditures, should focus on improving adherence in high-risk populations most likely to benefit from statin use." J Gen Intern Med 2004;19:638-645.
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