Impact of reimbursement changes on statin use among patients with diabetes in Austria.
BACKGROUND
Statins have evolved as cornerstones of cardiovascular prevention in patients with diabetes. They are effective and can be cost-effective therapies, but increased use imposes a sizeable short-term burden on payors of health care. These have used various instruments to steer appropriate use of such treatment. It was the purpose of this study to examine the effect of two reimbursement policy changes of statin therapy in patients with diabetes in Austria.


METHODS
Retrospective cohort study; time-series analysis. From Austrian sickness funds claims, we identified a closed cohort of 68,953 patients receiving treatment for diabetes in the first quarter of 2004. From April 2004 - December 2005, we ascertained use of statins for each monthly interval. Patients were censored at death. We used pseudo-experimental time-series regression to evaluate the effect of two policy changes on statin use and cost overall, as well as on the use of preferred versus non-preferred statins.


RESULTS
Statin use among Austrian patients with diabetes increased from 20.6% to 24.9% during the time period. A policy change essentially expanding reimbursement for statins from secondary to primary prevention among patients with diabetes had no discernible effect on the observed trends in statin use. Another policy change that imposed random chart review for appropriateness of prescription of non-preferred statins including atorvastatin 10 mg yielded a marked drop in use of atorvastatin 10 mg and increase in the use of preferred statins, while leaving overall trends in statin use unaffected.


CONCLUSIONS
Quantitative evaluation of new policies can provide important insights into the effectiveness und utility of such changes.
Winkelmayer
Wolfgang C
WC
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. wwinkelmayer@partners.org
Asslaber
Markus
M
Bucsics
Anna
A
Burkhardt
Thomas
T
Schautzer
Alexandra
A
Wieninger
Peter
P
Pogantsch
Michaela
M
Brookhart
M Alan
MA
D000368:Aged; D001317:Austria / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D015994:Incidence; D007349:Insurance, Health, Reimbursement / Q000191:economics* / Q000706:statistics & numerical data*; D008297:Male
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors