ABSTRACT
Title
Prescribing pattern and adherence to the statins therapy: a population-based study in Italian primary health care
Authors
L. Sportiello1, A. Capuano1, C. Ferrajolo1,2, C. Pagliaro3, I. Lombardi3, C. Sirianni4, R. Ferrara4, M.Tari3, A.P. Caputi4, F. Rossi1, V. Arcoraci4.
- Pharmacovigilance and Pharmacoepidemiology Centre of Campania Region, Dept. of Experimental Medicine, Pharmacology Section, Second University of Napoli, Italy.
- Pharmacoepidemiology Unit, Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands.
- CasertaLocal Health Unit, Caserta, Italy.
- Dept. of Clinical and Experimental Medicine and Pharmacology, University of Messina, Italy.
Abstract
In the last decade, the use of statins is considerably rising because of their role in the reduction of the cardiovascular morbidity and mortality among patients with dyslipidemia. The insufficient adherence to treatment might reduce statins protective effects.
We assess the prescribing pattern of statins and the adherence to the therapy in a setting of outpatients in southern Italy.
A population-based study was performed using data about people ≥ 15, living in the catchment area of Caserta and listed in Arianna database, a computerized database of longitudinal medical records from 118 general practitioners. During a 6 years period (January 2004 - December 2009), prevalence of use and incidence of new treatments of statins were calculated for each year, stratified by molecules. Statins medication adherence was measured by medication possession ratio (MPR). In the light of statins efficacy, a good adherence was considered with MPR ≥ 0.8. Sub-analyses by gender, age, and indication of use were performed.
Overall, the 1-year prevalence of statins use increased from 46.6 (IC 95% 45.4-47.8)/1,000 inhabitants in 2004 to 74,2 (72.8-75.6) in 2009 whereas a different prescribing pattern was observed for the incidence of new use: according with revision of reimbursement criteria a slight decrease was found from 16.6 (15.8-17.3) in 2004 to 13.4 (12.8-14.0) in 2005, followed by a progressive increase of incident use 15.0 (14.3-15.6) in 2006 to 18.0 (17.3-18.7) in 2009. The incidence of new treatment linearly decreased for atorvastatin, and slightly increased for rosuvastatin. Looking at the adherence to the treatment, the percentage of MPR ≥ 0.8 was higher in the first year of the follow-up (60.6%) to systematically decline for long-term observations (33.3% after 6 years of follow-up). Roughly 40% of patients >74 start a new treatment with statins even without major cardiovascular events or diabetes.
The use of statins was linearly increased from 2004-2009, although a slight decrease between 2004 and 2005 is likely influenced by reimbursement restriction. The inadequate adherence for long-term treatment could influence the efficacy of statins.
We assess the prescribing pattern of statins and the adherence to the therapy in a setting of outpatients in southern Italy.
A population-based study was performed using data about people ≥ 15, living in the catchment area of Caserta and listed in Arianna database, a computerized database of longitudinal medical records from 118 general practitioners. During a 6 years period (January 2004 - December 2009), prevalence of use and incidence of new treatments of statins were calculated for each year, stratified by molecules. Statins medication adherence was measured by medication possession ratio (MPR). In the light of statins efficacy, a good adherence was considered with MPR ≥ 0.8. Sub-analyses by gender, age, and indication of use were performed.
Overall, the 1-year prevalence of statins use increased from 46.6 (IC 95% 45.4-47.8)/1,000 inhabitants in 2004 to 74,2 (72.8-75.6) in 2009 whereas a different prescribing pattern was observed for the incidence of new use: according with revision of reimbursement criteria a slight decrease was found from 16.6 (15.8-17.3) in 2004 to 13.4 (12.8-14.0) in 2005, followed by a progressive increase of incident use 15.0 (14.3-15.6) in 2006 to 18.0 (17.3-18.7) in 2009. The incidence of new treatment linearly decreased for atorvastatin, and slightly increased for rosuvastatin. Looking at the adherence to the treatment, the percentage of MPR ≥ 0.8 was higher in the first year of the follow-up (60.6%) to systematically decline for long-term observations (33.3% after 6 years of follow-up). Roughly 40% of patients >74 start a new treatment with statins even without major cardiovascular events or diabetes.
The use of statins was linearly increased from 2004-2009, although a slight decrease between 2004 and 2005 is likely influenced by reimbursement restriction. The inadequate adherence for long-term treatment could influence the efficacy of statins.