The effects of reduced copayments on discontinuation and adherence failure to statin medication in Australia.
This paper assesses whether the concession card, which offers discounted out-of-pocket costs for prescription medicines in Australia, affects discontinuation and adherence to statin therapy. The analysis uses data from the Australian Hypertension and Absolute Risk Study (AusHEART), which involves patients aged 55 years and over who visited a GP between April and June 2008. Socioeconomic and clinical information was collected and linked to administrative data on pharmaceutical use. Patients without a concession card were 63% more likely (hazard ratio (HR) 95% confidence interval (CI): 1.14-2.33) to discontinue and 60% (odds ratio (OR) CI: 1.04-2.44) more likely to fail to adhere to therapy compared to concessional patients. Smokers were 2.12 (HR CI: 1.39-3.22) times more likely to discontinue use and 2.23 (OR CI: 1.35-3.71) times more likely to fail to adhere compared to non-smokers. Patients who had recently initiated statin medication were also 2.28 (HR CI: 1.22-4.28) times more likely to discontinue use. In conclusion, higher copayments act as a disincentive for persistent and adherent use of statin medication.
Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Parkville, 3010 VIC, Australia; Centre for Health Economics, Monash University, Level 2, Building 75, Clayton, 3800 VIC, Australia. Electronic address: rachel.knott@monash.edu.
Rachel J
RJ
Knott
Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Parkville, 3010 VIC, Australia. Electronic address: dennis.petrie@unimelb.edu.au.
Dennis J
DJ
Petrie
The George Institute for Global Health, 83/117 Missenden Rd, Camperdown, 2050 NSW, Australia; Sydney Medical School, University of Sydney, Edward Ford Building A27, 2006 NSW, Australia. Electronic address: eheeley@georgeinstitute.org.au.
Emma L
EL
Heeley
The George Institute for Global Health, 83/117 Missenden Rd, Camperdown, 2050 NSW, Australia; Sydney Medical School, University of Sydney, Edward Ford Building A27, 2006 NSW, Australia. Electronic address: chalmers@georgeinstitute.org.au.
John P
JP
Chalmers
Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Parkville, 3010 VIC, Australia. Electronic address: philip.clarke@unimelb.edu.au.
Philip M
PM
Clarke
D000368:Aged; D001315:Australia; D003669:Deductibles and Coinsurance; D005260:Female; D005102:Health Expenditures; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D006973:Hypertension / Q000188:drug therapy*; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
Adherence; Australian Pharmaceutical Benefits Scheme; Co-payments; Discontinuation; Statins