OUTCOMES, HEALTH COSTS AND USE OF STATINS IN 6,226

Aldo Pietro Maggioni°,
Elisa Cinconze#,
Elisa Rossi#,
Marisa DeRosa#,
Immacolata Esposito*,
Nello Martini*
on the behalf of the
ARNO Observatory*
[email protected]
www.coreteam.it
www.cineca.it
°Centro Studi ANMCO,
Firenze, CORE Bologna
# CINECA Interuniversity
Consortium, Bologna,
Italy
*Accademia Nazionale di
Medicina, Roma
* ARNO Observatory
OUTCOMES, HEALTH COSTS AND USE OF STATINS IN 6,226 PATIENTS
ADMITTED IN 2011 FOR AN ACUTE CORONARY SYNDROME (ACS)
OCCURRING IN A LARGE COMMUNITY SETTING OF 2,989,512 SUBJECTS
Background and Objective
Randomized clinical trials or specialty observational studies generally provide information that are not
representative of the real world situation, being patients selected on the basis of specific eligibility criteria.
The aim of this study was to assess in a community setting how patients discharged alive after an ACS are
treated with statins. Specifically, the rate of prescription, the dosages and the 1-year adherence have been
evaluated.
Methods
From the ARNO Observatory, we carried out a record linkage analysis of discharge records for ACS and
prescription databases, which included 2,989,512 subjects of 7 Local Health Authorities from Northern to
Southern Italy. The accrual period lasted from January 1 to December 31, 2011. Discharge records and
prescription patterns were analyzed for 1 year before and after the accrual period to identify the events and
the prescriptions reported before and after that period.
Prescription continuity to statin therapy was defined when patients received a prescription of an amount of
statins during the whole year of follow-up consistent with a daily treatment for at least 300 out of 365 days.
Patients were evaluated for costs during the 1 year follow-up period from the NHS perspective. Costs items
considered were: drugs in charge to NHS (estimated based on reimbursement prices), diagnostic procedures
(estimated using reimbursement tariffs), hospitalizations (estimated using DRG).
network (LHUs):
Of the 2,989,512 subjects, 6,226 (2.1‰) were
hospitalized for ACS over the 12 months of
observation:
• 58% of patients were aged more than 70 years
• Females accounted for 36% of the cases
• In-hospital all-cause death was 4.6%
Gender, age distribution and comorbidities are
reported in figure 1.
Of the patients discharged alive, 69.9% received a
statin treatment at the time of discharge. High dosage
of statins were used in 70.4% of cases (figure 2).
After 1 year follow-up, adherence to treatment was
observed in 71.7% of patients (figure 3).
Figure 2: Statins: rate of use and dosages prescribed at
discharge after ACS: 4,933/5,937=(83.1%).
Figure 1: patient profile
7%
30%
35.5%
64.5%
Rosuvastatin
Hypertension
1.56%
10mg
Pravastatin
0.6%
20mg
Lovastatin
0.07%
40mg
Fluvastatin
0.03%
80mg
Simvastatin and ezetimibe
<50
14.6%
9.5%
4.0%
0.2
2.1
50-59
30.8%
10
4.1
60-69
6.2
70-79
9.1
>=80
2.1
Total
Figure 3: Prescription continuity of statins over 1 year
follow-up.
80
70
20
40
% patients
71.7
64.3
56.6
60
60
43.1
50
Rate
0
71.4%
5
5mg
11.7%
Simvastatin
Prevalence rate (‰)
0
COPD
Neoplasm
14.9%
13%
23%
Comorbidities
Diabetes
42.5%
<50
50-59
60-69
70-79
>=80
28%
Depression
Atorvastatin
Age classes
Gender
years
R.Roni (Trento), A. De Marco
(Belluno), M.Cecchetto
(Bassano), MP Cariolato
(Ovest Vicentino), A.Maroni
(Vicenza), D.Maccari (Pieve di
Soligo), R.Callegari (Asolo),
M.Ferrari (San Donà di Piave),
S.Zardo (Venezia) L.Cordella
(Mirano), B.Pari (Chioggia),
A.Pedrini (Alta Padovana),
A.Grion (Padova), MG Zogno
(Monselice), A.Ferrarese
(Rovigo), V.Lolli (Adria),
L.Mezzalira (Verona),
S.Brasola (Legnago),
L.Castellani (Bussolengo),
D.Garibaldi (Lucca), P.Batacchi
(Firenze), M.Rais (Viareggio),
G.Riccioni (Roma A), R.Di Turi
(Roma D), C. De Matthaeis
(Roma F), A. Orsini (Teramo),
G. La Bella (Napoli1), E.Nava
(Napoli 3), R.Moscogiuri
(Taranto)
Results
42.8
40
40
28.6
22.9
30
20
10
Over the 1-year follow-up period, 63.3% of the
patients needed to be readmitted again (50.4% for
cardiovascular causes) (figure 4).
The average yearly cost per patient for the total
ACS population was 14,871€/year (figure 5).
63.3
Statins
Figure 5: 1-year total costs per patient. NHS costs per year
for 1 patient admitted for ACS = € 14,871.
4.9% 3.3% 5.5%
Other drugs (€ 494)
32.6
30.5
20.8
CV drugs (€ 821)
7.7
5.8
2.5
Total
No CV reasons
Total CV reasons
Other CV reasons
STROKE/ TIA
CABG/PCI
Hospitalizations (€ 12,836)
HF
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
67.4
ACS
% readmissions
Figure 4: re-hospitalizations during the 1-year follow-up
period. Total number of readmissions = 8,201.
0
Diagnostic/ specialistic
procedures (€ 720)
86.3%
Conclusions
ISPOR 20th Annual
International
Meeting
May 16-20, 2015
Philadelphia, PA,
USA
In a community setting, the rate of prescription of statins after an ACS seems to be suboptimal. However,
the dosages of prescribed statins suggest that the use of intensive statin treatment increased over the last
few years. Prescription continuity over time was not adequately followed.
Patients with ACS have high direct healthcare costs, rehospitalization being the main cost driver.
There is still a gap between evidence based recommendations and what actually happens in the routine
clinical practice, possibly determining a high social and economical burden for the national health
structures.