title: Relationship between adherence level to statins, clinical issues and health-care costs in real-life clinical setting.
abstract: OBJECTIVE
  Statins have been shown to reduce the risk of major cardiovascular disease. We recognize that there is a major gap between the use of statins in actual practice and treatment guidelines for dyslipidemia. Low adherence to statins may have a significant impact on clinical issues and health-care costs. The objective is to evaluate the impact of low adherence to statins on clinical issues and direct health-care costs.
  
  
  METHODS
  A cohort of 55,134 patients newly treated with statins was reconstructed from the Régie de l'Assurance Maladie du Québec and Med-Echo databases. Subjects included were aged between 45 and 85, initially free of cardiovascular disease, newly treated with statins between 1999 and 2002, and followed-up for a minimum of 3 years. Adherence to statins was measured in terms of the proportion of days' supply of medication dispensed over a defined period, and categorized as >or=80% or <80%. The adjusted odds ratio (OR) of cardiovascular events between the two adherence groups was estimated using a polytomous logistic analysis. The mean costs of direct health-care services were evaluated. A two-part model was applied for hospitalization costs.
  
  
  RESULTS
  The mean high adherence level to statins was around to 96% during follow-up; and this value was at 42% for the low adherence level. The patients with low adherence to statins were more likely to have coronary artery disease (OR 1.07; 95% confidence interval [CI], 1.01-1.13), cerebrovascular disease (OR 1.13; 95% CI 1.03-1.25), and chronic heart failure within 3-year period of follow-up (OR 1.13; 95% CI 1.01-1.26). Low adherence to statins was also associated with an increased risk of hospitalization by 4% (OR 1.04; 95% CI 1.01-1.09). Among patients who were hospitalized, low adherence to statins was significantly associated with increase of hospitalization costs by approximately $1060/patient for a 3-year period.
  
  
  CONCLUSIONS
  Low adherence to statins was correlated with a higher risk of cardiovascular disease, hospitalization rate, and hospitalization costs. An increased level of adherence to statins agents should provide a better health status for individuals and a net economic gain.
authors.affiliation: Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Alice
authors.initials: A
authors.lastname: Dragomir
authors.forename: Robert
authors.initials: R
authors.lastname: Côté
authors.forename: Michel
authors.initials: M
authors.lastname: White
authors.forename: Lyne
authors.initials: L
authors.lastname: Lalonde
authors.forename: Lucie
authors.initials: L
authors.lastname: Blais
authors.forename: Anick
authors.initials: A
authors.lastname: Bérard
authors.forename: Sylvie
authors.initials: S
authors.lastname: Perreault
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D050171:Dyslipidemias / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence / Q000191:economics / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics / Q000706:statistics & numerical data; D011792:Quebec / Q000453:epidemiology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors