Document Detail

Impact of out-of-pocket expenses on discontinuation of statin therapy: a cohort study in Finland.
MedLine Citation:
PMID:  21410736     Owner:  NLM     Status:  MEDLINE    
WHAT IS KNOWN AND OBJECTIVE: Out-of-pocket expenses of drug therapy may negatively affect adherence. We aimed to analyse 1-year discontinuation rates between cohorts initiating therapy with either generic simvastatin or non-generic atorvastatin.
METHODS: Statin-naìve initiators of atorvastatin and generic simvastatin in April-June 2003, and corresponding cohorts in 2005, were identified through the nationwide Finnish prescription register. Persistence with statin therapy was followed for 365 days, considering the treatment to have been discontinued when the tablet-free gap between two consecutive refills exceeded 90 days. Using multivariate-adjusted logistic regression, odds ratios (OR) for discontinuation associated with initiating with simvastatin vs. atorvastatin were estimated separately for each year.
RESULTS AND DISCUSSION: In the year 2003, 5838 persons initiated treatment with atorvastatin and 5644 with generic simvastatin. In the year 2005, the respective numbers were 5228 and 10 987. Soon after the introduction of generic substitution in 2003, there was no difference in the risk of discontinuation between the comparator groups [OR 0·97, 95% confidence interval (CI) 0·89-1·05]. Two years later, persons initiating with generic simvastatin were 20% less likely to discontinue statin therapy (OR 0·80; 95% CI 0·74-0·83). Among persons whose medicinal costs were almost completely reimbursed towards the end of the initiation year, the OR was 1·14 (95% CI 0·76-1·64, P = 0·033 for interaction).
WHAT IS NEW AND CONCLUSIONS: We found that lower out-of-pocket expenses associated with the initiating statin had a positive impact on persistence with therapy. The finding does not seem to apply to persons with minor copayments towards the end of the initiation year.
A Helin-Salmivaara; M J Korhonen; T Alanen; R Huupponen
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-03-16
Journal Detail:
Title:  Journal of clinical pharmacy and therapeutics     Volume:  37     ISSN:  1365-2710     ISO Abbreviation:  J Clin Pharm Ther     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-01-26     Completed Date:  2012-05-14     Revised Date:  2012-09-10    
Medline Journal Info:
Nlm Unique ID:  8704308     Medline TA:  J Clin Pharm Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  58-64     Citation Subset:  IM    
Copyright Information:
© 2011 Blackwell Publishing Ltd.
Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Finland.
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MeSH Terms
Aged, 80 and over
Cohort Studies
Drug Costs
Drug Substitution / economics
Drugs, Generic / administration & dosage,  economics
Follow-Up Studies
Heptanoic Acids / administration & dosage*,  economics
Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage*
Insurance, Health, Reimbursement / economics
Insurance, Pharmaceutical Services / economics
Logistic Models
Medication Adherence / statistics & numerical data*
Middle Aged
Multivariate Analysis
Pyrroles / administration & dosage*,  economics
Registries / statistics & numerical data
Simvastatin / administration & dosage*,  economics
Reg. No./Substance:
0/Drugs, Generic; 0/Heptanoic Acids; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 0/Pyrroles; 110862-48-1/atorvastatin; 79902-63-9/Simvastatin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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