Currently Viewing:
The American Journal of Managed Care December 2017
Chronic Disease Outcomes From Primary Care Population Health Program Implementation
Jeffrey M. Ashburner, PhD, MPH; Daniel M. Horn, MD; Sandra M. O’Keefe, MPH; Adrian H. Zai, MD, PhD; Yuchiao Chang, PhD; Neil W. Wagle, MD, MBA; and Steven J. Atlas, MD, MPH
Expanding the "Safe Harbor" in High-Deductible Health Plans: Better Coverage and Lower Healthcare Costs
A. Mark Fendrick, MD, and Rashna Soonavala
Impact of Consumer-Directed Health Plans on Low-Value Healthcare
Rachel O. Reid, MD, MS; Brendan Rabideau, BA; and Neeraj Sood, PhD
Insurance Switching and Mismatch Between the Costs and Benefits of New Technologies
David Cutler, PhD; Michael Ciarametaro, MBA; Genia Long, MPP; Noam Kirson, PhD; and Robert Dubois, MD, PhD
ED-Based Care Coordination Reduces Costs for Frequent ED Users
Michelle P. Lin, MD, MPH; Bonnie B. Blanchfield, ScD, CPA; Rose M. Kakoza, MD, MPH; Vineeta Vaidya, MS; Christin Price, MD; Joshua S. Goldner, MD; Michelle Higgins, PA-C; Elisabeth Lessenich, MD, MPH; Karl Laskowski, MD, MBA; & Jeremiah D. Schuur, MD, MHS
Evaluation of the Quality Blue Primary Care Program on Health Outcomes
Qian Shi, PhD, MPH; Thomas J. Yan, MS; Peter Lee, BS; Paul Murphree, MD, MHA; Xiaojing Yuan, MPH; Hui Shao, PhD, MHA; William H. Bestermann, MD; Selina Loupe, BS; Dawn Cantrell, BA; David Carmouche, MD; John Strapp, BA; and Lizheng Shi, PhD, MSPharm
Investigating the Impact of Intervention Refusal on Hospital Readmission
Alexis Coulourides Kogan, PhD; Eileen Koons, MSW, ACSW; and Susan Enguidanos, PhD
Real-World Economic Value of a 21-Gene Assay in Early-Stage Breast Cancer
Stanley E. Waintraub, MD; Donna McNamara, MD; Deena Mary Atieh Graham, MD; Andrew L. Pecora, MD; John Min, BS; Tommy Wu, BA; Hyun Gi Noh, MSC; Jacqueline Connors, RN, OCN; Ruth Pe Benito, MPH, BS; Kelly Choi, MD; Eric Schultz, BS; & Stuart L. Goldberg, MD
Trends in Bisphosphonate Initiation Within an Integrated Healthcare Delivery System
Rami J. Hosein, MD, MPH; Joan C. Lo, MD; Bruce Ettinger, MD; Bonnie H. Li, MS; Fang Niu, MS; Rita L. Hui, PharmD, MS; and Annette L. Adams, PhD, MPH
Reduction of Emergency Department Use in People With Disabilities
Lihao Chu, PhD; Neeraj Sood, PhD; Michael Tu, MS; Katrina Miller, MD; Lhasa Ray, MD; and Jennifer N. Sayles, MD
Currently Reading
Impact of Statin Guidelines on Statin Utilization and Costs in an Employer-Based Primary Care Clinic
Holly E. Gurgle, PharmD, BCACP, CDE; Marisa B. Schauerhamer, PharmD; Simón A. Rodriguez, PharmD; and Carrie McAdam-Marx, MSCI, PhD, RPh

Impact of Statin Guidelines on Statin Utilization and Costs in an Employer-Based Primary Care Clinic

Holly E. Gurgle, PharmD, BCACP, CDE; Marisa B. Schauerhamer, PharmD; Simón A. Rodriguez, PharmD; and Carrie McAdam-Marx, MSCI, PhD, RPh
Adherence to clinical guidelines in practice is often suboptimal and controversial. This study compares actual statin utilization and cost with full adoption of major clinical guidelines in a real-world population.
In this patient cohort, implementation of ACC/AHA compared with ATPIII guidelines or actual statin use increased the intensity of statin utilization, with overall neutral effects on cost when generic statins are emphasized. Implementation of USPSTF recommendations may lower costs slightly compared with ACC/AHA and may improve identification of high-risk primary prevention patients. Application of any of these statin guidelines would result in improved statin utilization and fairly neutral cost effects in this employer-based population. Further research is needed to more fully understand the clinical and economic impact of lipid guideline implementation and barriers to guideline adherence within real-world patient cohorts. 

Author Affiliations: Department of Pharmacotherapy, University of Utah College of Pharmacy (HEG, MBS, SAR, CM), Salt Lake City, UT; ARUP Laboratories, Family Health Clinic (HEG), Salt Lake City, UT; Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences College of Pharmacy (CM), Little Rock, AR.

Source of Funding: None.

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article. 

Authorship Information: Concept and design (HEG, MBS, CM); acquisition of data (SAR); analysis and interpretation of data (HEG, MBS, SAR, CM); drafting of the manuscript (HEG, MBS, SAR); critical revision of the manuscript for important intellectual content (HEG, CM); administrative, technical, or logistic support (MBS); and supervision (HEG, CM). 

Address Correspondence to: Holly E. Gurgle, PharmD, BCACP, CDE, Department of Pharmacotherapy, University of Utah College of Pharmacy, 30 S 2000 E, Room 4836, Salt Lake City, UT 84112-5820. E-mail: holly.gurgle@pharm.utah.edu.
REFERENCES

1. Mozaffarian D, Benjamin EJ, Go AS, et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation. 2015;131(4):e29-e322. doi: 10.1161/CIR.0000000000000152.

2. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report [erratum in Circulation. 2014;129(25 suppl 2):S46-S48]. Circulation. 2002;106(25):3143-3421.

3. Grundy SM, Cleeman JI, Merz CN, et al; Coordinating Committee of the National Cholesterol Education Program. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. J Am Coll Cardiol. 2004;44(3):720-732. doi: 10.1016/j.jacc.2004.07.001.

4. Stone NJ, Robinson JG, Lichtenstein AH, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 suppl 2):S1-S45. doi: 10.1161/01.cir.0000437738.63853.7a.

5. US Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, et al. Statin use for the primary prevention of cardiovascular disease in adults: US Preventive Services Task Force recommendation statement. JAMA. 2016;316(19):1997-2007. doi: 10.1001/jama.2016.15450.

6. Rana JS, Tabada GH, Solomon MD, et al. Accuracy of the atherosclerotic cardiovascular risk equation in a large contemporary, multiethnic population. J Am Coll Cardiol. 2016;67(18):2118-2130. doi: 10.1016/j.jacc.2016.02.055.

7. Cook NR, Ridker PM. Further insight into the cardiovascular risk calculator: the roles of statins, revascularizations, and underascertainment in the Women’s Health Study. JAMA Intern Med. 2014;174(12):1964-1971. doi: 10.1001/jamainternmed.2014.5336.

8. DeFilippis AP, Young R, Carrubba CJ, et al. An analysis of calibration and discrimination among multiple cardiovascular risk scores in a modern multiethnic cohort. Ann Intern Med. 2015;162(4):266-275. doi: 10.7326/M14-1281.

9. Pencina MJ, Navar-Boggan AM, D’Agostino RB Sr, et al. Application of new cholesterol guidelines to a population-based sample. N Engl J Med. 2014;370(15):1422-1431. doi: 10.1056/NEJMoa1315665.

10. Chia YC, Lim HM, Ching SM. Does use of pooled cohort risk score overestimate the use of statin? a retrospective cohort study in a primary care setting. BMC Fam Pract. 2014;15:172. doi: 10.1186/s12875-014-0172-y.

11. Maddox TM, Borden WB, Tang F, et al. Implications of the 2013 ACC/AHA cholesterol guidelines for adults in contemporary cardiovascular practice: insights from the NCDR PINNACLE registry. J Am Coll Cardiol. 2014;64(21):2183-2192. doi: 10.1016/j.jacc.2014.08.041.

12. Pursnani A, Massaro JM, D’Agostino RB Sr, O’Donnell CJ, Hoffmann U. Guideline-based statin eligibility, coronary artery calcification, and cardiovascular events. JAMA. 2015;314(2):134-141. doi: 10.1001/jama.2015.7515.

13. Lewis SJ, Robinson JG, Fox KM, Grandy S; SHIELD Study Group. Underutilisation of cardiovascular medications among at-risk individuals. Int J Clin Pract. 2010;64(5):604-610. doi: 10.1111/j.1742-1241.2009.02258.x.
PDF
 
Copyright AJMC 2006-2018 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up
×

Sign In

Not a member? Sign up now!