心肌梗死后他汀类药物相关不良反应的 Medicare 受益人群的医疗支出。

Medical Expenditures Among Medicare Beneficiaries with Statin-Associated Adverse Effects Following Myocardial Infarction.

机构信息

Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave South, RPHB 527C, Birmingham, AL, 35294-0013, USA.

Peter Munk Cardiac Centre, University of Toronto, Toronto, ON, Canada.

出版信息

Cardiovasc Drugs Ther. 2018 Dec;32(6):601-610. doi: 10.1007/s10557-018-6840-8.

DOI:10.1007/s10557-018-6840-8

PMID:30446883

Abstract

PURPOSE

Compare medical expenditures among adults with statin-associated adverse effects (SAAE) and high statin adherence (HSA) following myocardial infarction (MI).

METHODS

We analyzed expenditures in 2016 US dollars among Medicare beneficiaries with SAAE (n = 1741) and HSA (n = 55,567) who were ≥ 66 years of age and initiated moderate/high-intensity statins following an MI in 2007-2013. SAAE were identified through a claims-based algorithm, which included down-titrating statins and initiating ezetimibe, switching to ezetimibe monotherapy, having a rhabdomyolysis or antihyperlipidemic adverse event followed by statin down-titration or discontinuation, or switching between ≥ 3 statin types within 365 days following MI. HSA was defined by having a statin available to take for ≥ 80% of the days in the 365 days following MI.

RESULTS

Expenditures among beneficiaries with SAAE and HSA were $40,776 (95% CI $38,329-$43,223) and $26,728 ($26,482-$26,974), respectively, in the 365 days following MI, and $34,238 ($31,396-$37,080) and $29,053 ($28,605-$29,500), respectively, for every year after the first 365 days. Multivariable-adjusted ratios comparing expenditures among beneficiaries with SAAE versus HSA in the first 365 days and after the first 365 days following MI were 1.51 (95% CI 1.43-1.59) and 1.23 (1.12-1.34), respectively. Inpatient and outpatient expenditures were higher among beneficiaries with SAAE versus HSA during and after the first 365 days following MI. Compared to beneficiaries with HSA, medication expenditures among those with SAAE were similar in the 365 days following MI, but higher afterwards. Other medical expenditures were higher among beneficiaries with SAAE versus HSA.

CONCLUSION

SAAE are associated with increased expenditures following MI compared with HSA.

摘要

目的

比较他汀类药物相关不良反应（SAAE）和高他汀类药物依从性（HSA）成年人在心肌梗死后的医疗支出。

方法

我们分析了 2007 年至 2013 年期间，年龄在 66 岁及以上且在心肌梗死后开始使用中等/高强度他汀类药物的 Medicare 受益人的支出，这些患者在 2016 年以美元计算存在 SAAE（n=1741）和 HSA（n=55567）。通过基于索赔的算法确定 SAAE，该算法包括降低他汀类药物剂量和开始使用依折麦布、转为依折麦布单药治疗、发生横纹肌溶解或降脂不良事件后降低他汀类药物剂量或停药、或在心肌梗死后 365 天内将≥3 种他汀类药物转换。HSA 定义为在心肌梗死后 365 天内，有他汀类药物可供服用的天数≥80%。

结果

在心肌梗死后 365 天内，SAAE 和 HSA 受益人的支出分别为 40776 美元（95%CI 38329 美元至 43223 美元）和 26728 美元（26482 美元至 26974 美元），而在第一次 365 天后的每年支出分别为 34238 美元（31396 美元至 37080 美元）和 29053 美元（28605 美元至 29500 美元）。在第一次 365 天和心肌梗死后第一次 365 天后，与 HSA 相比，SAAE 受益人的支出调整后比值分别为 1.51（95%CI 1.43-1.59）和 1.23（1.12-1.34）。在心肌梗死后的第一个 365 天内和之后，与 HSA 相比，SAAE 受益人的住院和门诊支出均较高。与 HSA 相比，SAAE 受益人的药物支出在心肌梗死后的 365 天内相似，但之后更高。与 HSA 相比，SAAE 受益人的其他医疗支出更高。