Pan Yun-Yi, Devabhakthuni Sandeep, Cooke Catherine E, Slejko Julia F
Department of Practice, Sciences and Health Outcomes Research, University of Maryland School of Pharmacy, 220 Arch Street, Baltimore, MD, 21201, USA.
Drugs Real World Outcomes. 2025 Mar;12(1):75-81. doi: 10.1007/s40801-024-00472-9. Epub 2024 Dec 21.
Performing lipid testing after statin initiation is recommended to monitor response. Inadequate response may indicate non-adherence, which is associated with an increased risk of cardiovascular events and increased costs. Group-based trajectory modeling is an approach to establish probabilistic developmental trajectories of adherence, differentiating individuals by their distinct longitudinal medication-taking behaviors. We examined whether lipid testing is associated with distinct trajectories of statin adherence among individuals enrolled in a Medicare fee-for-service plan in the USA.
A retrospective cohort study was conducted using the Centers for Medicare & Medicaid Chronic Condition Warehouse 5% sample of Medicare fee-for-service data between 2006 and 2015. Statin use and lipid testing were identified using claims data. The proportion of days covered was calculated for each 30 days after the index date, which was used to estimate the probability of belonging to each potential adherence trajectory.
In a cohort of 138,101 statin initiators, four statin adherence trajectory groups were identified. The four groups were differentiated as "rapid decline" (21.53%), "gradual decline" (10.25%), "decline first then improve later" (26.47%), and "high adherence" (41.75%). Compared with "high adherence," initiators who had lipid tests within 360 days after statin initiation were less likely to fall into "rapid decline" (adjusted odds ratio: 0.661; 95% confidence interval 0.641-0.683), "gradual decline" (adjusted odds ratio: 0.834; 95% confidence interval 0.801-0.868), and "decline first then improve later" groups (adjusted odds ratio: 0.936; 95% confidence interval 0.910-0.962).
Lipid testing is positively associated with greater use of statin medication across different adherence trajectories in the present study.
建议在开始使用他汀类药物后进行血脂检测以监测反应。反应不足可能表明未坚持用药，这与心血管事件风险增加及成本上升相关。基于群体的轨迹建模是一种建立用药依从性概率发展轨迹的方法，通过个体独特的纵向用药行为对其进行区分。我们研究了在美国参加医疗保险按服务付费计划的人群中，血脂检测是否与他汀类药物依从性的不同轨迹相关。
使用医疗保险和医疗补助中心慢性病仓库2006年至2015年医疗保险按服务付费数据的5%样本进行回顾性队列研究。利用索赔数据确定他汀类药物的使用和血脂检测情况。计算索引日期后每30天的覆盖天数比例，用于估计属于每个潜在依从性轨迹的概率。
在138,101名开始使用他汀类药物的人群中，确定了四个他汀类药物依从性轨迹组。这四组分别为“快速下降”（21.53%）、“逐渐下降”（10.25%）、“先下降后改善”（26.47%）和“高依从性”（41.75%）。与“高依从性”相比，在开始使用他汀类药物后360天内进行血脂检测的起始者不太可能属于“快速下降”组（调整后的优势比：0.661；95%置信区间0.641 - 0.683）、“逐渐下降”组（调整后的优势比：0.834；95%置信区间0.801 - 0.868）和“先下降后改善”组（调整后的优势比：0.936；95%置信区间0.910 - 0.962）。
在本研究中，血脂检测与不同依从性轨迹下他汀类药物的更多使用呈正相关。
