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

PurposeCompare medical expenditures among adults with statin-associated adverse effects (SAAE) and high statin adherence (HSA) following myocardial infarction (MI).MethodsWe analyzed expenditures in 2016 US dollars among Medicare beneficiaries with SAAE (n=1741) and HSA (n=55,567) who were 66years 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 365days following MI. HSA was defined by having a statin available to take for 80% of the days in the 365days following MI.ResultsExpenditures 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 365days following MI, and $34,238 ($31,396-$37,080) and $29,053 ($28,605-$29,500), respectively, for every year after the first 365days. Multivariable-adjusted ratios comparing expenditures among beneficiaries with SAAE versus HSA in the first 365days and after the first 365days 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 365days following MI. Compared to beneficiaries with HSA, medication expenditures among those with SAAE were similar in the 365days following MI, but higher afterwards. Other medical expenditures were higher among beneficiaries with SAAE versus HSA.ConclusionSAAE are associated with increased expenditures following MI compared with HSA.