Long-term persistence with XXXX treatment in a not-for-profit health maintenance organization: a population-based retrospective cohort study in Israel.

@entity1 @entity101 @entity6 @entity1780 @entity453 @entity65 @entity165
BACKGROUND: Although discontinuing lipid-lowering treatment can cause preventable morbidity, previously published reports have indicated considerable variability in persistence with @entity1780 use. In general, such reports have been limited by short follow-up periods and modest study populations. OBJECTIVES: The aims of this study were to assess long-term persistence with statins and to identify the sociodemographic, clinical, and pharmacotherapy-related factors associated with long-term persistence with @entity1780 treatment in first-time users in Israel. METHODS: This retrospective cohort study used data from adult enrollees of a not-for-profit health maintenance organization and from death certificates in Israel. Eligible @entity1 initiated @entity1780 treatment between 1998 and 2006. Persistence was assessed separately in @entity1 with no indication of a @entity65 (primary prevention) or @entity453 (secondary prevention). Treatment persistence and proportion of days covered (PDC) were measured using the interval between the date of the first prescription dispensation (index date) and the point of discontinuation. RESULTS: Data from 229,918 @entity1 were included (primary prevention, 136,052; secondary prevention, 93,866). The PDC was significantly higher in the secondary-prevention group compared with the primary-prevention group (59% vs 45%; P < 0.001). In both cohorts, persistence continually diminished from the index date through follow-up, with > or = 75% of @entity1 discontinuing @entity1780 therapy by 2 years. Baseline predictors of discontinuation of @entity1780 treatment included younger age, female sex, lower socioeconomic status (SES), absence of @entity6 or @entity101 , no concurrent use of beta-blockers or angiotensin-converting enzyme inhibitors, and less health service utilization. New immigrants and @entity1 in the primary-prevention group who had a baseline low-density lipoprotein @entity165 concentration <130 mg/dL were at increased risk for treatment discontinuation. CONCLUSION: In this study in these @entity1 receiving first-time @entity1780 treatment in Israel, we found poor persistence with statins among both the primary- and secondary-prevention cohorts, especially among new immigrants and @entity1 with low SES despite low out-of-pocket prescription costs and free access to health services.
