Effect of an intervention to increase statin use in medicare members who qualified for a medication therapy management program.

摘要

BACKGROUND: The cardiovascular (CV) benefits of lipid-lowering therapy in older adults with hypercholesterolemia and underlying risk factors for coronary artery disease (CAD) have been well documented. Significant reductions in the risk of myocardial infarction (MI) and coronary death have been demonstrated with statin therapy, benefits that are of particular relevance in patients with diabetes. Managed care interventions with prescribers have increased the use of selected drugs such as statins. OBJECTIVES: To (1) measure the increase in new users of statins associated with the implementation of a statin initiation intervention aimed at prescribers for Medicare Part D Medication Therapy Management Program (MTMP) members with diabetes or CAD and (2) estimate the potential cost savings associated with the projected reduction in CV events based on published controlled trials. METHODS: Medicare Advantage Prescription Drug (MA-PD) and prescription drug plan (PDP) members of a pharmacy benefits manager (PBM)were identified for the intervention who (1) met the criteria for MTMP (expected to incur at least dollars 4,000 in annual pharmacy expenditures for Part D-covered medications, filled at least 10 distinct Part D-covered medications, and had at least 3 of 5 chronic diseases of interest); (2) were identified as having diabetes or CAD (patients with a history of MI were considered to have CAD); and (3) had no pharmacy claims for a statin between January and June 2006. In August 2006, the primary prescribers for antidiabetic or CV medications of 1,144 identified members were sent educational materials and a report listing their patients with diabetes or CAD who were not receiving statin therapy. A comparison group of MA-PD members (N = 700) with diabetes or CAD was identified who did not receive the intervention but who met all of the MTMP criteria except the presence of at least 3 of 5 chronic diseases of interest. Logistic regression was conducted to evaluate the intervention effectiveness after adjusting for age, gender, geography, and chronic disease score. To determine the implications of this intervention for routine practice, outcome measures included estimates of (1) the number of patient interventions necessary to prevent 1 major CV event and (2) the coronary event costs avoided by the intervention. The number of interventions necessary to prevent 1 major CV event was estimated by (1) calculating the number of members requiring interventions in order for 1 member to initiate statin therapy, based on the present study's findings, and then (2) calculating the number of statin initiations necessary to avoid a major CV event, based on clinical trial estimates of the effect of statin treatment on CV event rates. RESULTS: During the 4-month period following the intervention, 12.1% (n = 138) of the intervention members started a statin medication compared with 7.3% (n =51) of comparison members (P = 0.001). After covariate adjustment, the odds of initiating a statin medication were 65% higher (adjusted odds ratio [OR] = 1.65; 95% confidence interval [CI] = 1.15-2.36; P = 0.006) in the intervention than in the comparison group. The estimated number of members requiring interventions to prevent 1 major CV event was 220. The estimated coronary event cost avoidance is dollars 12,323 per 220 members who received the intervention, after subtraction of program administrative costs and the cost of statin drug therapy. CONCLUSION: A statin initiation intervention aimed at prescribers for MA-PD and PDP members with diabetes or CAD who qualified for MTMP services was successful in increasing statin use among this group of members at high risk for CV events.