Harley Caroline R, Gandhi Sanjay K, Anoka Nze, Bullano Michael F, McKenney James M
Health Economics and Outcomes, i3 Innovus, 12125 Technology Drive, Minnesota, MN 55244, USA.
Am J Manag Care. 2007 Dec;13 Suppl 10:S276-81.
To understand the practice patterns and National Cholesterol Education Panel (NCEP) Adult Treatment Panel (ATP) III low-density lipoprotein cholesterol (LDL-C) goal attainment rates after switching patients from simvastatin (SMV) to other statins or the combination of SMV and ezetimibe (EZE).
This retrospective study linked claims and laboratory data from a national health plan. Patients were included if they were taking SMV and were switched to other statins or a fixed-dose combination of SMV and EZE between July 1, 2005, and June 30, 2006. Patients taking dual SMV/EZE before switch were excluded from the study. The NCEP ATP III risk status of patients at switch was assessed based on medical claims, pharmacy claims, and laboratory values in the 12-month preswitch period. Lipid data (available on a patient subset) were used to estimate patients' goal attainment status at and after switch.
Of 134 168 patients taking SMV, 11 929 (8.9%) switched to other statins or SMV/EZE. The mean age of switching patients was 54 years (standard deviation, 9 years), 61% were men, 50% were high risk, and 30% were moderate risk. The mean time to switch among new starters of SMV (n = 3379) was 77 days. Forty percent (n = 4772) of the total switches occurred among those taking the lower doses (5, 10, and 20 mg) of SMV. Most patients switched from SMV to SMV/EZE (60.5%), followed by atorvastatin (17.3%), rosuvastatin (10.1%), lovastatin (8.6%), pravastatin (2.9%), and fluvastatin (0.7%). Similarly, most patients switching from higher doses of SMV switched to SMV/EZE (52.5%), followed by atorrestatin (21.1%) and rosuvastatin (10.1%). Overall, 55.6% (758 of 1362) of patients were at ATP III goal at the time of switch from SMV (across all doses; n = 758), and 56.1% (292 of 521) of those taking lower doses were at goal at time of switch. A majority (69.9%) of patients who were at goal and switched from SMV (across all doses) were switched to SMV/EZE, and 61.6% of those at lower doses of SMV switched to the combination drug. Of patients who were not at goal at switch (n = 604), 73.3% attained ATP III LDL-C goal after switch. The mean percent LDL-C reduction that was needed to attain LDL-C goal at switch from SMV (n = 604) was 18.1%.
There is an opportunity to further increase LDL-C goal attainment rates among patients switched from SMV. The clinical, prescription benefit design, and economic implications of the finding that a majority of patients are at goal when switched from SMV and a majority of patients are being switched from SMV to SMV/EZE need to be further examined.
了解患者从辛伐他汀（SMV）换用其他他汀类药物或换用辛伐他汀与依泽替米贝（EZE）联合用药后的治疗模式以及达到美国国家胆固醇教育计划（NCEP）成人治疗组（ATP）III低密度脂蛋白胆固醇（LDL-C）目标的比率。
这项回顾性研究将来自一项全国性健康计划的理赔数据和实验室数据相联系。纳入2005年7月1日至2006年6月30日期间正在服用SMV并换用其他他汀类药物或辛伐他汀与依泽替米贝固定剂量联合用药的患者。换用前服用辛伐他汀与依泽替米贝联合用药的患者被排除在研究之外。根据换用前12个月内的医疗理赔、药房配药记录和实验室检查值评估患者换用时的NCEP ATP III风险状态。脂质数据（仅部分患者有记录）用于评估患者换用时及换用后的目标达成状态。
在134168例服用SMV的患者中，11929例（8.9%）换用了其他他汀类药物或辛伐他汀与依泽替米贝联合用药。换用患者的平均年龄为54岁（标准差9岁），61%为男性，50%为高危患者，30%为中危患者。辛伐他汀新使用者（n = 3379）的平均换用时间为77天。在服用低剂量（5、10和20毫克）辛伐他汀的患者中，40%（n = 4772）进行了换用。大多数患者从辛伐他汀换用为辛伐他汀与依泽替米贝联合用药（60.5%），其次是阿托伐他汀（17.3%）、瑞舒伐他汀（10.1%）、洛伐他汀（8.6%）、普伐他汀（2.9%）和氟伐他汀（0.7%）。同样，从高剂量辛伐他汀换用的大多数患者换用为辛伐他汀与依泽替米贝联合用药（52.5%），其次是阿托伐他汀（21.1%）和瑞舒伐他汀（10.1%）。总体而言，从辛伐他汀换用（所有剂量；n = 758）时，55.6%（1362例中的758例）的患者达到了ATP III目标，服用低剂量辛伐他汀的患者中56.1%（521例中的292例）在换用时达到了目标。达到目标且从辛伐他汀换用（所有剂量）的患者中，大多数（69.9%）换用为辛伐他汀与依泽替米贝联合用药，服用低剂量辛伐他汀的患者中有61.6%换用了联合用药。换用时未达到目标的患者（n = 604）中，73.3%在换用后达到了ATP III LDL-C目标。从辛伐他汀换用时（n = 604）达到LDL-C目标所需的LDL-C平均降低百分比为18.1%。
从辛伐他汀换用的患者有进一步提高LDL-C目标达成率的机会。大多数患者从辛伐他汀换用时达到目标以及大多数患者从辛伐他汀换用为辛伐他汀与依泽替米贝联合用药这一发现的临床、处方效益设计及经济意义有待进一步研究。
