title: Optimizing statin treatment decisions for diabetes patients in the presence of uncertain future adherence.
abstract: Statins are an important part of the treatment plan for patients with type 2 diabetes. However, patients who are prescribed statins often take less than the prescribed amount or stop taking the drug altogether. This suboptimal adherence may decrease the benefit of statin initiation.
  
  
  
  To estimate the influence of adherence on the optimal timing of statin initiation for patients with type 2 diabetes.
  
  
  
  The authors use a Markov decision process (MDP) model to optimize the treatment decision for patients with type 2 diabetes. Their model incorporates a Markov model linking adherence to treatment effectiveness and long-term health outcomes. They determine the optimal time of statin initiation that minimizes expected costs and maximizes expected quality-adjusted life years (QALYs).
  
  
  
  In the long run, approximately 25% of patients remain highly adherent to statins. Based on the MDP model, generic statins lower costs in men and result in a small increase in costs in women relative to no treatment. Patients are able to noticeably increase their expected QALYs by 0.5 to 2 years depending on the level of adherence.
  
  
  
  Adherence-improving interventions can increase expected QALYs by as much as 1.5 years. Given suboptimal adherence to statins, it is optimal to delay the start time for statins; however, changing the start time alone does not lead to significant changes in costs or QALYs.
authors.affiliation: Edward P. Fitts Department of Industrial & Systems Engineering, North Carolina State University, Raleigh, North Carolina (JEM, BTD)
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Mason
authors.affiliation: Ingenix, Eden Prairie, Minnesota (DAE)
authors.forename: Darin A
authors.initials: DA
authors.lastname: England
authors.affiliation: Edward P. Fitts Department of Industrial & Systems Engineering, North Carolina State University, Raleigh, North Carolina (JEM, BTD)
authors.forename: Brian T
authors.initials: BT
authors.lastname: Denton
authors.affiliation: Division of Endocrinology, Diabetes, Nutrition, & Metabolism and Division of Health Care Policy & Research, Knowledge and Encounter Research Unit, Mayo Clinic College of Medicine, Rochester, Minnesota (SAS, NDS)
authors.forename: Steven A
authors.initials: SA
authors.lastname: Smith
authors.affiliation: Industrial Engineering Department, University of Pittsburgh, Pittsburgh, Pennsylvania (MK)
authors.forename: Murat
authors.initials: M
authors.lastname: Kurt
authors.affiliation: Division of Endocrinology, Diabetes, Nutrition, & Metabolism and Division of Health Care Policy & Research, Knowledge and Encounter Research Unit, Mayo Clinic College of Medicine, Rochester, Minnesota (SAS, NDS)
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
mesh_terms: D000328:Adult; D003657:Decision Making; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D010349:Patient Compliance; D019057:Quality-Adjusted Life Years
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors