BACKGROUND: Adherence to lipid lowering therapy is reported to have consequences on atherosclerotic cardiovascular diseases (ASCVD) outcomes and healthcare resource use. In the real-world practice, adherence to statins is proved to be a major issue in Chinese patients, while the level of adherence to anti-PCSK9 monoclonal antibody (mAb) is still unclear.

OBJECTIVES: To evaluate the real-world adherence to anti-PCSK9 mAb and its relation to cardiovascular economic burden in China.

METHODS: A retrospective study was conducted using regional EMR database, including Tianjin, Inner Mongolia, Shandong and Hunan province. In this analysis, adult patients who initiated an anti-PCSK9 mAb from January 1, 2022 with at least a 6-month follow-up were included and grouped into ASCVD and ASCVD high-risk subgroups according to their history and risk levels of ASCVD during the 6-month pre-index period. Adherence to anti-PCSK9 mAb at 6 and 12-month were collected using proportion of days covered (PDC), where PDC≥80% is defined as good adherence. Annual costs related to cardiovascular visits and hospitalization were also collected.

RESULTS: Data were analyzed for 4848 ASCVD and 2700 high-risk patients. Among ASCVD group, the mean PDC was 20.2% (95%CI,12.7%–30.2%) and 12.5% (95%CI,9.4–16.5) at 6 and 12-month respectively, with only 3.2% and 0.9% patients being adherent (PDC≥80%). The adherent group had reduced annual costs for cardiovascular visits compared with the non-adherent (￥14584 vs.￥15802, p<0.05). Similar results were observed in ASCVD high-risk patients, where the mean PDC was 20.7% (95%CI,13.2%–30.7%) and 15.3% (95%CI,11.8%–19.5%), at 6 and 12-month respectively, and only 2.7% and 0.7% patients had PDC≥80%. Good adherence was significantly associated with cost saving comparing to non-adherence (￥8794 vs. ￥17315, p<0.05).

CONCLUSIONS: Anti-PCSK9 mAb adherence was poor in China with a significant impact on cardiovascular economic burden. There is a need to optimize treatment adherence to improve lipid management.