Adherence to single-pill combination versus multiple-pill combination lipid-modifying therapy among patients with mixed dyslipidemia in a managed care population

Abstract

Background:

Suboptimal adherence to lipid-lowering therapies is associated with and potentially contributes to increased cardiovascular morbidity and mortality. Single-pill combination (SPC) lipid-modifying therapies may improve patient adherence due to decreased pill burden and increased convenience for the patient.

Objective:

To compare adherence to SPC versus multi-pill combination (MPC) lipid-modifying medications.

Methods:

This retrospective study used pharmacy and medical claims and laboratory result data from a national managed care dataset to evaluate patients who were newly prescribed simvastatin plus ezetimibe, simvastatin plus niacin, and lovastatin plus niacin either as SPC or MPC. Patients were considered adherent to therapy if they had a proportion of days covered (PDC) ≥0.80.

Results:

The mean PDC was 0.76 and 0.70 in the first 3 months of therapy, 0.54 and 0.45 in the second 3 months, and 0.50 and 0.41 for the remaining 30 months of follow-up for the SPC and MPC groups, respectively. SPC patients were 32% (OR = 1.32; 95% CI: 1.27–1.36; P < 0.01) more likely to be adherent to treatment than MPC patients.

Conclusion:

Adherence was significantly higher among patients receiving SPC than MPC. Although only associations and not temporality were assessed due to the observational design of this study, the use of SPC may be a successful method for improving adherence in a real-world setting.

Key words::

• Drug therapy, combination
• Dyslipidemias
• Managed care programs
• Medication adherence

Transparency

Declaration of funding

This research was supported by AstraZeneca Pharmaceuticals LP.

Declaration of financial/other relationships

S.K.G. and M.F.B. are employees of AstraZeneca Pharmaceuticals LP. S.A.K., C-L.C and M.J.C did not have any financial incentives associated with AstraZeneca other than performing research services under this research grant.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgements

The authors thank Catherine E. Cooke of PosiHealth, Inc., for writing and editorial assistance which was supported by AstraZeneca Pharmaceuticals LP.

Data were previously presented at ISPOR 15th Annual International Meeting, Atlanta, GA, May 15–19, 2010.