title: Comparative effectiveness of generic and brand-name statins on patient outcomes: a cohort study.
abstract: BACKGROUND
  Statins are effective in preventing cardiovascular events, but patients do not fully adhere to them.
  
  
  OBJECTIVE
  To determine whether patients are more adherent to generic statins versus brand-name statins (lovastatin, pravastatin, or simvastatin) and whether greater adherence improves health outcomes.
  
  
  METHODS
  Observational, propensity score-matched, new-user cohort study.
  
  
  METHODS
  Linked electronic data from medical and pharmacy claims.
  
  
  METHODS
  Medicare beneficiaries aged 65 years or older with prescription drug coverage between 2006 and 2008.
  
  
  METHODS
  Initiation of a generic or brand-name statin.
  
  
  METHODS
  Adherence to statin therapy (measured as the proportion of days covered [PDC] up to 1 year) and a composite outcome comprising hospitalization for an acute coronary syndrome or stroke and all-cause mortality. Hazard ratios (HRs) and absolute rate differences were estimated.
  
  
  RESULTS
  A total of 90,111 patients who initiated a statin during the study was identified; 83,731 (93%) initiated a generic drug, and 6380 (7%) initiated a brand-name drug. The mean age of patients was 75.6 years, and most (61%) were female. The average PDC was 77% for patients in the generic group and 71% for those in the brand-name group (P<0.001). An 8% reduction in the rate of the clinical outcome was observed among patients in the generic group versus those in the brand-name group (HR, 0.92 [95% CI, 0.86 to 0.99]). The absolute difference was -1.53 events per 100 person-years (CI, -2.69 to -0.19 events per 100 person-years).
  
  
  CONCLUSIONS
  Results may not be generalizable to other populations with different incomes or drug benefit structures.
  
  
  CONCLUSIONS
  Compared with those initiating brand-name statins, patients initiating generic statins were more likely to adhere and had a lower rate of a composite clinical outcome.
  
  
  BACKGROUND
  Teva Pharmaceuticals.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Gagne
authors.forename: Niteesh K
authors.initials: NK
authors.lastname: Choudhry
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Kesselheim
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Polinski
authors.forename: David
authors.initials: D
authors.lastname: Hutchins
authors.forename: Olga S
authors.initials: OS
authors.lastname: Matlin
authors.forename: Troyen A
authors.initials: TA
authors.lastname: Brennan
authors.forename: Jerry
authors.initials: J
authors.lastname: Avorn
authors.forename: William H
authors.initials: WH
authors.lastname: Shrank
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control; D015331:Cohort Studies; D016568:Drugs, Generic / Q000191:economics; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D006278:Medicare; D055118:Medication Adherence; D011306:Prescription Fees; D057216:Propensity Score; D014481:United States
chemical_list: D016568:Drugs, Generic; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors