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Algorithms to Identify Statin Intolerance in Medicare Administrative Claim Data

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Abstract

Purpose

To compare characteristics of patients with possible statin intolerance identified using different claims-based algorithms versus patients with high adherence to statins.

Methods

We analyzed 134,863 Medicare beneficiaries initiating statins between 2007 and 2011. Statin intolerance and discontinuation, and high adherence to statins, defined by proportion of days covered ≥80 %, were assessed during the 365 days following statin initiation. Definition 1 of statin intolerance included statin down-titration or discontinuation with ezetimibe initiation, having a claim for a rhabdomyolysis or antihyperlipidemic event followed by statin down-titration or discontinuation, or switching between ≥3 types of statins. Definition 2 included beneficiaries who met Definition 1 and those who down-titrated statin intensity. We also analyzed beneficiaries who met Definition 2 of statin intolerance or discontinued statins.

Results

The prevalence of statin intolerance was 1.0 % (n = 1320) and 5.2 % (n = 6985) using Definitions 1 and 2, respectively. Overall, 45,266 (33.6 %) beneficiaries had statin intolerance by Definition 2 or discontinued statins and 55,990 (41.5 %) beneficiaries had high adherence to statins. Compared with beneficiaries with high adherence to statins, those with statin intolerance and who had statin intolerance or discontinued statins were more likely to be female versus male, and black, Hispanic or Asian versus white. The multivariable adjusted odds ratio for statin intolerance by Definitions 1 and 2 comparing patients initiating high versus low/moderate intensity statins were 2.82 (95%CI: 2.42–3.29), and 8.58 (8.07–9.12), respectively, and for statin intolerance or statin discontinuation was 2.35 (2.25–2.45).

Conclusions

Definitions of statin intolerance presented herein can be applied to analyses using administrative claims data.

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Authors and Affiliations

  1. Department of Epidemiology, University of Alabama at Birmingham, 1700 University Boulevard, LHL 450, Birmingham, AL, 35294, USA

    Lisandro D. Colantonio, Shia T. Kent, Lei Huang, Ligong Chen, Maria-Corina Serban & Paul Muntner

  2. Center for Observational Research, Amgen, Inc, Thousand Oaks, CA, USA

    Keri L. Monda & Angelika Manthripragada

  3. University of Medicine and Pharmacy “Victor Babes” Timisoara, Timisoara, Romania

    Maria-Corina Serban

  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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  2. Shia T. Kent
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  3. Lei Huang
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  4. Ligong Chen
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  5. Keri L. Monda
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  6. Maria-Corina Serban
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  7. Angelika Manthripragada
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  8. Meredith L. Kilgore
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  9. Robert S. Rosenson
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  10. Paul Muntner
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Corresponding author

Correspondence to Paul Muntner.

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Funding

The design and conduct of the study, analysis, and interpretation of the data, and preparation of the manuscript, was supported through a research grant from Amgen, Inc. (Thousand Oaks, CA). The academic authors conducted all analyses and maintained the rights to publish this article.

Conflict of Interest

STK received research support from Amgen, Inc. KLM and AM work in the Center for Observational Research at Amgen, Inc. KLM and AM also have stock ownership in Amgen, Inc. MLK, RSR and PM receive research support from Amgen, Inc. RSR also receives research support from Medicines Company, Regeneron and Sanofi, and serves on Advisory Boards for Amgen, Inc., Regeneron and Sanofi. LDC, LH, LC and MCS have no disclosures.

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Colantonio, L.D., Kent, S.T., Huang, L. et al. Algorithms to Identify Statin Intolerance in Medicare Administrative Claim Data. Cardiovasc Drugs Ther 30, 525–533 (2016). https://doi.org/10.1007/s10557-016-6680-3

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  • DOI: https://doi.org/10.1007/s10557-016-6680-3

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