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Pharmacoutilization of statin therapy after acute myocardial infarction. A real practice analysis based on
Luca Degli Esposti1, Mirko Di Martino, Stefania Saragoni
1CliCol Srl-Health, Economics and Outcomes Research, Ravenna, Italy. luca.degliesposti@clicon.it
Insights
Statin therapy use after acute myocardial infarction increased from 1996 to 2000, with more patients receiving adequate doses. Despite improvements, statin prescribing remains suboptimal, indicating a need for better drug management strategies.
Area of Science:
- Cardiology
- Pharmacoeconomics
- Public Health
Background:
- Continuous statin therapy is proven to reduce morbidity and mortality post-acute myocardial infarction (AMI).
- A significant gap exists in the undertreatment or inadequate treatment of high-risk patients with statins.
- This study addresses the critical need to evaluate real-world statin utilization following AMI.
Purpose of the Study:
- To analyze trends in statin prescription and utilization in patients discharged with acute myocardial infarction.
- To assess the adequacy of statin dosing and its associated costs over a five-year period.
- To identify improvements in pharmacoutilization and drug management for AMI patients.
Main Methods:
- Retrospective cohort study using an administrative database from the Local Health Unit of Ravenna (1996-2000).
- Analysis of 2265 patients discharged alive with AMI, focusing on statin prescriptions filled within six months post-discharge.
- Patients classified by statin exposure and pharmacoutilization based on prescription data.
Main Results:
- Statin treatment increased from 22.6% in 1996 to 43.8% in 2000.
- Adequately dosed patients rose from 4.3% to 23.9% during the study period.
- Total statin costs increased, but the proportion and average cost per adequately dosed patient also rose, indicating improved treatment intensity.
Conclusions:
- Statin pharmacoutilization post-AMI was initially unsatisfactory but showed a positive trend.
- Increasing exposure and adequate dosing suggest growing awareness and improved drug management.
- Further efforts are needed to optimize statin therapy for all eligible AMI patients.
Background:
Despite randomized and controlled trials indicating continuous treatment with statin therapy as a factor in reducing morbidity and mortality after acute myocardial infarction, records reveal a high percentage of patients at risk who are either not receiving treatment or being treated inadequately.
Methods:
An administrative database kept by the Local Health Unit of Ravenna and listing patient baseline characteristics, drug prescriptions and hospital admissions was used to perform: 1) an analysis of patients discharged alive from hospital each year between 1996 and 2000 with a diagnosis of acute myocardial infarction, and 2) a retrospective cohort study of drug utilization, and particularly the use of statins, year by year. All prescriptions for statins filled in the 6 months after hospital discharge were considered and used to classify patients in terms of their exposure to statin therapy and of their pharmacoutilization.
Results:
A total of 2265 subjects were enrolled (446 in 1996, 440 in 1997, 443 in 1998, 443 in 1999, and 493 in 2000). The percentage of patients treated with statins increased each year (from 22.6% in 1996 to 43.8% in 2000) as did the percentage of adequately dosed patients (from 4.3% in 1996 to 23.9% in 2000). The overall cost of dispensed statins amounted to 10,610 euros in 1996 and 45,102 euros in 2000. The proportion of cost for statins accountable to adequately dosed patients ranged from 36.4% in 1996 to 77.4% in 2000. The average cost per adequately dosed patient ranged from 203.40 euros in 1996 to 296.00 euros in 2000 and increased year by year.
Conclusions:
Pharmacoutilization of statin therapy was found to be unsatisfactory in each study year. Interestingly, however, the trend indicated by the study suggests increasing percentages of patients being exposed to the treatment, and of adequately dosed patients. These results may be attributed to a greater awareness of the need for proper treatment, and may be considered as reflecting a significant improvement in drug management.
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