Effect of Access to Prescribed PCSK9 Inhibitors on Cardiovascular Outcomes

作者：Kelly D. Myers, Niloofar Farboodi, M Mwamburi, William H. Howard, David Staszak, Samuel S. Gidding, Seth J. Baum, Katherine Wilemon, Daniel J. Rader · 发表于：Circulation Cardiovascular Quality and Outcomes · 年份：2019 · DOI：10.1161/circoutcomes.118.005404 · 被引用次数：103 · 研究领域：Lipoproteins and Cardiovascular Health、Medication Adherence and Compliance、Pharmaceutical Economics and Policy

BACKGROUND: Atherosclerotic cardiovascular disease remains a major cause of death and disability, especially for high-risk familial hypercholesterolemia individuals. PCSK9i (proprotein convertase subtilisin kexin type 9 inhibitors) reduce low-density lipoprotein cholesterol levels and cardiovascular event rates. However, PCSK9i prescriptions are rejected at high rates by payers, and use is often delayed or eventually abandoned as a treatment option. We tested the hypothesis that acute coronary syndromes, coronary interventions, stroke, and cardiac arrest are more prevalent in patients with rejected or abandoned PCSK9i prescriptions than for those with paid PCSK9i prescriptions. METHODS AND RESULTS: We identified 139 036 individuals aged ≥18 years who met the following 3 criteria: prescribed PCSK9i between August 2015 and December 2017, had claims history, and had an established date of exposure for paid, rejected, or abandoned status. To compare the effects of rejected versus paid and abandoned versus paid status, propensity score matching was performed to minimize confounding because of baseline differences in patient groups. Cox regression analyses and incidence density rates for cardiovascular events were estimated on the propensity score-matched cohorts. Patients who received 168 or more days of paid PCSK9i medication within a 12-month period were defined as paid. The hazard ratios for composite cardiovascular events outcome in propensity score-matched analyses were 1.10 ...