Ellis' co-author, UMHS Director of Pharmacy Services James Stevenson, Pharm.D., notes that the lack of adherence to cholesterol-lowering drugs might have something to do with the fact that there are no daily symptoms of having high cholesterol.
"Patients don't necessarily feel any different, so they don't get regular positive reinforcement for being on statins," he says. "But of course we know there's a direct preventive benefit from long term use. We should try to set up systems that encourage patients to stay on these drugs, and improve compliance."
The senior author on the paper, U-M professor of internal medicine A. Mark Fendrick, M.D., agrees. "Adherence appears to be lousy in both moderate and high-risk patients. To get the biggest 'bang for the buck' out of efforts to improve patient behavior, we first need to focus on improving adherence in those high-risk populations who are most likely to benefit," he says. He spurred the development of the new study in order to document the effect of co-pay level on adherence for patients with different levels of risk.
For several years, Fendrick has championed a concept he calls "benefit-based co-pay" that would charge patients different co-pay amounts based on how much they stand to benefit from taking a particular medication. Under the system, for example, a patient who has survived a heart attack and still has high cholesterol would pay less each time he or she refills a statin prescription than a person who has high blood cholesterol levels but no history of heart attack. Some patients might even pay nothing for a refill. Ellis adds, "There's solid evidence that statin use among heart attack survivors is more beneficial than for those with no heart history."