Ye Xin, Gross Cynthia R, Schommer Jon, Cline Richard, St Peter Wendy L
College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA.
Clin Ther. 2007 Dec;29(12):2748-57. doi: 10.1016/j.clinthera.2007.12.022.
Despite substantial evidence supporting the effectiveness of statin treatment, when administered regularly for the secondary prevention of coronary heart disease (CHD), many patients are not adherent.
The objective of this study was to examine the relationship between copayment and adherence to statin treatment among patients who initiated statin treatment after discharge from a CHD hospitalization.
Databases containing inpatient admission, outpatient, enrollment, and pharmacy claims from 1999 to 2003 were utilized for this study. The sample consisted of adults who initiated statin treatment after hospitalization directly related to CHD. Adherence to statins was measured by medication possession ratio (MPR), a surrogate marker of adherence calculated as a percentage of days with statins on hand during a 1-year observation period. The relationship between copayment and adherence to statin treatment was examined using multivariate logistic regression models. Demographic and clinical characteristics were selected as control variables based on modified versions of the Andersen health services utilization model as well as previous study findings.
A total of 5,548 patients met the study entry criteria and were included in the analysis. Of this number, 3,404 patients (61.4%) had an MPR of >or=80% and were considered adherent to statins. Compared with those who had a copayment <USD10, patients with a copayment >or=USD20 were significantly less likely to be adherent to statins (odds ratio, 0.42; 95% CI, 0.36-0.49). Other relevant factors significantly associated with low adherence were younger age (P < 0.001), female sex (P < 0.001), absence of dyslipidemia diagnosis (P < 0.001), presence of depression (P = 0.010), and concomitant use of nonstatin lipid-lowering drugs (P < 0.001).
Adherence during the 1-year period after statin initiation among CHD hospitalized patients was suboptimal, with more than one third of the patients not adherent to statin treatment. High prescription copayment appeared to be a significant barrier to statin adherence, even after adjusting for demographic and clinical variables.
尽管有大量证据支持他汀类药物治疗的有效性，在用于冠心病（CHD）二级预防的常规治疗中，许多患者并不坚持用药。
本研究的目的是探讨冠心病住院出院后开始他汀类药物治疗的患者中，自付费用与他汀类药物治疗依从性之间的关系。
本研究使用了包含1999年至2003年住院患者入院、门诊、登记和药房报销数据的数据库。样本包括因与冠心病直接相关的疾病住院后开始他汀类药物治疗的成年人。他汀类药物的依从性通过药物持有率（MPR）来衡量，MPR是一种依从性替代指标，计算方法为在1年观察期内手头有他汀类药物的天数占比。使用多因素逻辑回归模型研究自付费用与他汀类药物治疗依从性之间的关系。根据安德森医疗服务利用模型的修改版本以及先前的研究结果，选择人口统计学和临床特征作为控制变量。
共有5548名患者符合研究纳入标准并纳入分析。其中，3404名患者（61.4%）的MPR≥80%，被认为坚持服用他汀类药物。与自付费用<10美元的患者相比，自付费用≥20美元的患者坚持服用他汀类药物的可能性显著降低（比值比，0.42；95%置信区间，0.36 - 0.49）。与低依从性显著相关的其他因素包括年龄较小（P < 0.001）、女性（P < 0.001）、无血脂异常诊断（P < 0.001）、存在抑郁症（P = 0.010）以及同时使用非他汀类降脂药物（P < 0.001）。
冠心病住院患者开始服用他汀类药物后的1年内依从性欠佳，超过三分之一的患者未坚持他汀类药物治疗。即使在调整人口统计学和临床变量后发现，高处方自付费用似乎仍是他汀类药物依从性的一个重要障碍。
