CLAIMS-BASED LIPID-LOWERING THERAPY COVERAGE COMPARED TO CONVENTIONAL DRUG-SPECIFIC MEDICATION ADHERENCE AND PERSISTENCE METRICS
Author(s)
Julius L. Katzmann, MD1, Claudia Grellmann, PhD2, Martin Schulz, PhD1, Ulrich Laufs, MD1.
1Universitätsklinikum Leipzig, Leipzig, Germany, 2inav – privates Institut für angewandte Versorgungsforschung GmbH, Berlin, Germany.
1Universitätsklinikum Leipzig, Leipzig, Germany, 2inav – privates Institut für angewandte Versorgungsforschung GmbH, Berlin, Germany.
OBJECTIVES: Adherence and persistence to specific lipid-lowering therapies (LLT) are frequently reported as low. Treatment gaps, re-initiation, and drug switching are common. Measuring total time on LLT across substance groups (“LLT coverage”) may therefore better reflect the expected clinical benefits.
METHODS: Analyses based on claims data administered by “Gesundheitsforen Leipzig GmbH” (~4.4 million individuals). In individuals with at least two LLT prescriptions between 2016 and 2023, drug-specific good adherence (proportion of days covered ≥0.80) within the first year and persistence (absence of treatment gaps >90 days following the end of prescription coverage) were evaluated for statins, ezetimibe, bempedoic acid, and PCSK9 inhibitors. Additionally, LLT coverage was calculated as the proportion of patients on any LLT on each day throughout the observation period by an area-under-the-curve (AUC) approach.
RESULTS: A total of 266,241 patients were included (mean age 63.6 [SD, 11.9] years, 43.1% female, 54.5% with atherosclerotic cardiovascular disease). Based on the defined daily doses method, good adherence was found in 44.0% of patients. The persistence was 65.9% in the first year and declined during follow-up to 45.4% after 8 years. The persistence at 1 and 3 years was 65.5%/48.8% for statins, 62.2%/37.2% for ezetimibe, 67.8%/39.6% for bempedoic acid, and 69.6%/43.5% for PCSK9 inhibitors. LLT coverage showed a steep decline within the first 6 months after treatment initiation, but remained stable at 55% to 60% after 8 years of follow-up (after 1 and 3 years: 57.4%/55.5%). LLT coverage was higher for more recent LLT prescriptions and for LLT regimens that also included non-statins.
CONCLUSIONS: Commonly used definitions of drug-specific medication adherence and persistence to LLT resulted in lower estimates of treatment coverage compared with an AUC-based approach across substance groups. Coverage with LLT may serve as an additional marker to estimate the expected benefits of LLT at the population level.
METHODS: Analyses based on claims data administered by “Gesundheitsforen Leipzig GmbH” (~4.4 million individuals). In individuals with at least two LLT prescriptions between 2016 and 2023, drug-specific good adherence (proportion of days covered ≥0.80) within the first year and persistence (absence of treatment gaps >90 days following the end of prescription coverage) were evaluated for statins, ezetimibe, bempedoic acid, and PCSK9 inhibitors. Additionally, LLT coverage was calculated as the proportion of patients on any LLT on each day throughout the observation period by an area-under-the-curve (AUC) approach.
RESULTS: A total of 266,241 patients were included (mean age 63.6 [SD, 11.9] years, 43.1% female, 54.5% with atherosclerotic cardiovascular disease). Based on the defined daily doses method, good adherence was found in 44.0% of patients. The persistence was 65.9% in the first year and declined during follow-up to 45.4% after 8 years. The persistence at 1 and 3 years was 65.5%/48.8% for statins, 62.2%/37.2% for ezetimibe, 67.8%/39.6% for bempedoic acid, and 69.6%/43.5% for PCSK9 inhibitors. LLT coverage showed a steep decline within the first 6 months after treatment initiation, but remained stable at 55% to 60% after 8 years of follow-up (after 1 and 3 years: 57.4%/55.5%). LLT coverage was higher for more recent LLT prescriptions and for LLT regimens that also included non-statins.
CONCLUSIONS: Commonly used definitions of drug-specific medication adherence and persistence to LLT resulted in lower estimates of treatment coverage compared with an AUC-based approach across substance groups. Coverage with LLT may serve as an additional marker to estimate the expected benefits of LLT at the population level.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
PCR1
Topic
Patient-Centered Research, Real World Data & Information Systems, Study Approaches
Topic Subcategory
Adherence, Persistence, & Compliance
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)