Prevention and Rehabilitaion
Persistence and adherence to cholesterol lowering agents: Evidence from Régie de l'Assurance Maladie du Québec data

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Background

There is a concern that poor compliance to cholesterol lowering agents (CLA) may compromise their potential benefits. The objective of this study was to estimate compliance to CLAs, in the context of clinical practice in Quebec.

Methods

This study was performed using data from the Régie de l'Assurance Maladie du Québec Persistence and adherence to treatment were estimated separately. An index combining these 2 measures was also calculated.

Results

In a random sample of patients (n = 428 304) from the Régie de l'Assurance Maladie du Québec administrative database, 14 076 were new users of a CLA. After 24 months, the persistence rate with the statins was significantly higher than with other CLAs (83% vs 69%; P < .001). The proportion of patients who switched from their initial statin varied across the statins (ranging from 7% to 34%). The proportion of patients who were 80% adherent to their treatment was significantly lower with the other CLA than with statins (43% vs 60%, P < .001). A composite index combining monthly persistence and adherence was calculated. This index was significantly higher for atorvastatin than for the other CLAs (P < .001) and the other statins (P < .01), with the exception of simvastatin (P = .09).

Conclusions

Over a 2-year period, a large proportion of patients using a statin remained persistent to treatment. The overall rate of compliance (persistence and adherence) after 2 years was >60% with some statins.

Section snippets

Study sample

This retrospective cohort study was conducted using data from pharmaceutical and medical services and beneficiaries' demographics from the Quebec provincial drug plan (Régie de l'Assurance Maladie du Québec [RAMQ]) database. Since 1977, the RAMQ program has covered every person aged ≥65 years and the beneficiaries of the social assistance program. In January 1997, individuals who did not have access to a private medication insurance plan became eligible for coverage under the RAMQ program. At

Results

Data from the RAMQ for a random sample of 428 304 patients were obtained. Of these, 69 400 had used a CLA during the period from January 1, 1998 to December 31, 2002. A total of 16 923 patients had initially used a CLA during the period from January 1, 1999 to December 31, 2000. Finally, 14 076 of these latter patients were covered by the provincial drug plan for the entire study period from 1 year before the initial use of the CLA to 2 years after the initial use of that CLA (Figure 1).

The mean

Discussion

Treatment compliance to CLAs has been estimated in other studies, some of which used administrative databases from drug reimbursement programs.9, 15, 16 The results of this study are consistent with what has been reported in other studies: over time, there are a substantial number of patients who abandon their dyslipidemia treatment. In this study, persistence to treatment after 2 years was at 83.3% for the statins, and the average overall compliance with the statins, estimated with the

Conclusions

Persistence and adherence to treatment are essential for treatment success and vary substantially among the different therapeutic options. In this study, treatment compliance was estimated from the perspectives of adherence and persistence. Over a 2-year period, a large proportion of patients using a statin remained persistent to treatment. The overall rate of compliance (persistence and adherence) after 2 years was >60% with some statins.

Many clinical trials have demonstrated positive health

References (16)

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This study was supported by Pfizer Canada Inc, Kirkland, Quebec, Canada.

d

Current affiliation: Department of Clinical Epidemiology and Biostatistics, Master University, Hamilton, Ontario.

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