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Elderly patients more likely to adhere to generic statins than brand-name statins
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Elderly patients who initiated therapy with a generic statin had a better rate of medication adherence and a lower rate of hospitalization for ACS or stroke and all-cause mortality compared with patients who initiated therapy with a brand-name statin, according to new data.
Researchers analyzed the health records of 90,111 Medicare beneficiaries aged 65 years and older (mean age, 75.6 years) to determine whether patients were more adherent to generic statins or brand-name statins. The two primary outcomes were adherence to the index statin prescription and a composite CV outcome of hospitalization for ACS or stroke and all-cause mortality.
Ninety-three percent of patients initiated therapy with a generic statin and 7% initiated therapy with a brand-name statin. Most patients initiated simvastatin (69%; 57,493 in the generic group; 4,629 in the brand-name group), followed by pravastatin (18%; 14,304 in the generic group; 1,720 in the brand-name group) and lovastatin (13%; 11,965 in the generic group; 31 in the brand-name group).
Adherence, as measured by the proportion of days covered by the index statin, was 77% for the generic group vs. 71% for the brand-name group (P<.001).
The researchers observed an 8% reduction in the rate of hospitalization for ACS or stroke and all-cause mortality in the generic group compared with the brand-name group (HR=0.92; 95% CI, 0.86-0.99). The absolute difference in composite CV events between the groups was –1.53 events per 100 person-years. Censoring patients at the time of discontinuation to remove the potential mediating effect of medication persistence resulted in an HR of 1 (95% CI, 0.91-1.09), according to the study results.
“Among patients in our study, the mean copayment for the index statin prescription was $10 for generic-drug recipients and $48 for brand-name drug recipients. Our finding that adherence is greater with generic statins than with brand-name statins is therefore not surprising and is consistent with other studies that have shown a direct correlation between higher copayments and lower adherence,” Joshua J. Gagne, PharmD, ScD, from the division of pharmacoepidemiology and pharmacoeconomics at Brigham and Women’s Hospital and Harvard Medical School, and colleagues wrote. “However, to our knowledge, our study is the first to assess clinical effects of the decision to initiate a brand-name or generic medication.”
The researchers noted that these data may not be generalizable to other populations, including those with different income levels and drug benefit structures.
Disclosure: The study was supported by an unrestricted research grant from Teva Pharmaceuticals.
Perspective
Back to TopRhonda Cooper-DeHoff, PharmD, MS, FAHA, FACC
This manuscript represents some very important and new information. It is really the first to show that not only does use of a generic drug improve medication adherence, but also that the improved medication adherence translates to better outcomes. It has long been recognized that a number of factors influence adherence and, in the elderly population, which usually has a fixed and limited income, affordability is one of the most important factors. While the present study focused on generic simvastatin, now that generic atorvastatin is also available in a generic formulation there are affordable statins in all levels of statin intensity making primary and secondary prevention with statins affordable for most. As the price of atorvastatin continues to fall, these data suggest there may also be a continued reduction in CV risk.
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