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Patient Co-payment and Adherence to Statins: A Review and Case Studies

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Abstract

Purpose

This study aims to review the international literature about whether there is an association between co-payment and statin adherence, and to present case studies to illustrate the impact of a reduction in patient co-payment associated with generic drugs on improving therapy adherence.

Methods

Studies that examined the impact of patient co-payment on statin adherence were identified in PubMed, Cochrane Central Register of Controlled Trials and EconLit up to January 2013. A standardized data extraction form was completed for each included study, collecting information about country, sample, setting, adherence measure, design, results about the impact of co-payment on statin adherence, and methodological quality. Two cases from the outpatient clinic of one the authors (PRS) were added.

Results

The literature supported a statistically significant negative association between co-payment and statin adherence. This association appeared to be influenced by the absolute level of co-payments, the size of the co-payment change, whether co-payment increases or decreases, the time horizon over which the impact of a co-payment change is examined, the type of drug for which co-payment changes (e.g. generic or branded drug), the availability of alternative drugs and switching behaviour. Two case studies illustrated that cost issues are important to patients and that patient adherence to statin therapy improved following a switch to generic statins.

Conclusions

Current studies have demonstrated that statin adherence is influenced by co-payment and a range of patient, physician and pharmacy characteristics. Nevertheless, the power of these models to explain the variation in adherence remains limited.

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Acknowledgments

Financial support for this research was received from TEVA. The study sponsor did not have a role in the study design, in the collection, analysis and interpretation of data, in the writing of the manuscript, or in the decision to submit the manuscript for publication. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.

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Authors and Affiliations

  1. Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Onderwijs en Navorsing 2, Herestraat 49, P.O. Box 521, 3000, Leuven, Belgium

    Steven Simoens

  2. Department of Cardiovascular Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    Peter R. Sinnaeve

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  1. Steven Simoens
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Correspondence to Steven Simoens.

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Simoens, S., Sinnaeve, P.R. Patient Co-payment and Adherence to Statins: A Review and Case Studies. Cardiovasc Drugs Ther 28, 99–109 (2014). https://doi.org/10.1007/s10557-013-6497-2

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