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Medical Expenditures Among Medicare Beneficiaries with Statin-Associated Adverse Effects Following Myocardial Infarction

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Abstract

Purpose

Compare medical expenditures among adults with statin-associated adverse effects (SAAE) and high statin adherence (HSA) following myocardial infarction (MI).

Methods

We analyzed expenditures in 2016 US dollars among Medicare beneficiaries with SAAE (n = 1741) and HSA (n = 55,567) who were ≥ 66 years of age and initiated moderate/high-intensity statins following an MI in 2007–2013. SAAE were identified through a claims-based algorithm, which included down-titrating statins and initiating ezetimibe, switching to ezetimibe monotherapy, having a rhabdomyolysis or antihyperlipidemic adverse event followed by statin down-titration or discontinuation, or switching between ≥ 3 statin types within 365 days following MI. HSA was defined by having a statin available to take for ≥ 80% of the days in the 365 days following MI.

Results

Expenditures among beneficiaries with SAAE and HSA were $40,776 (95% CI $38,329–$43,223) and $26,728 ($26,482–$26,974), respectively, in the 365 days following MI, and $34,238 ($31,396–$37,080) and $29,053 ($28,605–$29,500), respectively, for every year after the first 365 days. Multivariable-adjusted ratios comparing expenditures among beneficiaries with SAAE versus HSA in the first 365 days and after the first 365 days following MI were 1.51 (95% CI 1.43–1.59) and 1.23 (1.12–1.34), respectively. Inpatient and outpatient expenditures were higher among beneficiaries with SAAE versus HSA during and after the first 365 days following MI. Compared to beneficiaries with HSA, medication expenditures among those with SAAE were similar in the 365 days following MI, but higher afterwards. Other medical expenditures were higher among beneficiaries with SAAE versus HSA.

Conclusion

SAAE are associated with increased expenditures following MI compared with HSA.

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Funding

The design and conduct of the study, interpretation of the results, and preparation of the manuscript were supported through a research grant from Amgen, Inc. (Thousand Oaks, CA).

Author information

Authors and Affiliations

  1. Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave South, RPHB 527C, Birmingham, AL, 35294-0013, USA

    Lisandro D. Colantonio, Luqin Deng, Ligong Chen & Paul Muntner

  2. Peter Munk Cardiac Centre, University of Toronto, Toronto, ON, Canada

    Michael E. Farkouh

  3. Amgen, Inc., Thousand Oaks, CA, USA

    Keri L. Monda, David J. Harrison & Juan F. Maya

  4. Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA

    Meredith L. Kilgore

  5. Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Robert S. Rosenson

Authors
  1. Lisandro D. Colantonio
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  3. Ligong Chen
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  4. Michael E. Farkouh
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  9. Paul Muntner
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Contributions

The academic authors conducted all analyses, drafted the manuscript, and maintained the rights to publish this article.

Corresponding author

Correspondence to Lisandro D. Colantonio.

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Conflict of Interest

KLM, DJH, and JFM are employed by and stockholders of Amgen. PM receives research support from Amgen. MEF and MLK receive research support from Amgen. RSR receives research support from Akcea, Amgen, AstraZeneca, Medicines Company, and Regeneron; is an Advisory Board member/consultant for C5, CVS Caremark, Regeneron, and Sanofi; receives honoraria from Akcea, Amgen, Kowa, and Pfizer; is a stockholder of MediMergent; and receives royalties from UpToDate. LDC, LD, and LC have no conflict of interest.

Ethical Approval

All procedures performed in the current student were conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Institutional Review Board at the University of Alabama at Birmingham and Centers for Medicare and Medicaid Services approved the study.

Informed Consent

This is a retrospective cohort study and formal consent was not required.

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Colantonio, L.D., Deng, L., Chen, L. et al. Medical Expenditures Among Medicare Beneficiaries with Statin-Associated Adverse Effects Following Myocardial Infarction. Cardiovasc Drugs Ther 32, 601–610 (2018). https://doi.org/10.1007/s10557-018-6840-8

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