The percentage of individuals 18 years and older who met the Proportion of Days Covered (PDC) threshold of 80 percent for statins during the measurement year.
' + 'A higher rate indicates better performance.
' + 'Intended Use
' + 'Performance measurement for health plans.
' + 'Data Sources
' + 'Prescription claims data.
' + 'Denominator
' + 'Individuals 18 years and older who prescription claimed ≥2 prescriptions for any statin or statin combination product on different dates of service in the treatment period.
' + 'Exclusions
' + 'Hospice and end-stage renal disease (ESRD).
' + 'Numerator
' + 'Individuals who met the PDC threshold of 80% during the measurement year.
' + 'HMG-CoA reductase inhibitors, also known as statins, are recommended for management of dyslipidemia and/or primary prevention of cardiovascular disease (CVD) in several treatment guidelines.' +
'
One study evaluated the association between medication adherence levels and major adverse cardiovascular events (MACE) or atherosclerotic disease (ATH) over two years. Claims data with 4,015 post-MI patients and 12,976 patients with ATH from a large US health insurance company was analyzed. In the post-MI cohort, fully-adherent (PDC≥80%) patients had a significantly lower rate of MACE than non-adherent patients (18.9% vs. 26.3%; hazard ratio [HR]: 0.73; p=0.0004). In the ATH cohort, fully adherent patients (PDC≥80%) had a significantly lower rate of MACE than non-adherent patients (8.42% vs. 17.17%; HR: 0.56; p<0.0001). This study showed PDC≥80% adherence in the post-MI population was associated with a lower rate of MACE and ATH.' +
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Another study aimed to evaluate the relationship between statin adherence and ischemic stroke (IS) in patients with diabetes. A cohort of 52,868 statin initiators with diabetes (1995-2006) using Finnish health registers was evaluated. Good adherence to statins (PDC ≥80%) was associated with a 23% decreased incidence of IS (95% CI 14-32%) compared with poor adherence (PDC<80%). This association remained broadly unchanged when stratified by sex, age, history of atherosclerotic cardiovascular disease or IS. There was a dose-response relationship between adherence level and the risk of IS (RR 0.63 [0.53-0.75] for PDC ≥ 80% versus PDC<20%, p for trend <0.0001). Sensitivity analyses supported the robustness of the analysis.' +
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Roebuck and colleagues in 2011 showed an increase in medication adherence (defined as the 80% threshold) reduced total annual health care spending primarily through decreased inpatient hospital days and emergency department visits. Regarding dyslipidemia, adherence decreased annual medical spending by $1,860 for a benefit-cost ratio of 3.1.' +
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In 2014, Choudhry et al.' +
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Similar findings were observed with statin adherence. In 2019 Chinthammit et al.' +
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Individuals in hospice care are excluded because the use of statins is meant for long-term therapeutic benefit, as these medications decrease the risk of cardiovascular events, and these therapeutic regimens may not be present or useful at the end of life or for palliative care. Individuals with ESRD are excluded because evidence from major clinical trials has failed to demonstrate benefits for statin therapy in patients with ESRD.' +
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This is a health plan performance measure that retrospectively evaluates the percentage of individuals 18 years and older who met the Proportion of Days Covered (PDC) threshold of 80 percent for statins during the measurement year using administrative data. This measure is not designed to be used for clinical decision making. It is intended for retrospective, population level assessment and is not intended to guide individual patient-care decisions.
' + 'Last Update: 27 Sep 2019
' + 'To qualify for the eligible population/denominator, individuals must have ≥2 prescription claims for a target medication on different dates of service. These prescription claims do not need to be for the same target medication (i.e. ' + singleAgent1 + ', ' + singleAgent2 + ') but do need to be on the target medication list.
' + 'In this example, the individual has prescription claims for target medications on 2 different dates of service. Since the prescription claims do not need to be for the same target medication, this individual would qualify for the eligible population/denominator.
' + 'In this example, the individual has prescription claims for 2 different target medications, but both are on the same date of service. Since the prescription claims need to be on different dates of service (even if for different medications), this individual would not qualify for the eligible population/denominator.
" + 'The treatment period starts with the first prescription claim for any ' + drugClass + ' medication, referred to as the index prescription start date (IPSD), and ends with the last day of the measurement year, death, or disenrollment, whichever occurs first. The treatment period must be at least 91 days long for the individual to be included in the measure denominator.
' + "For this example, the individuals's first prescription claim for the measurement year, referred to as the index prescription start date (IPSD), is on 3/25. The treatment period for the individual is only 282 days since the treatment period starts with the IPSD.
" + 'For this example, the individual's days' supply for the prescription claim on 10/15 extends beyond the end of the measurement year. The days' supply beyond the end of the measurement year does not count toward the days in the treatment period or the days covered.
" + 'For this example, the individual's first prescription claim for the measurement year, referred to as the index prescription start date (IPSD), is on 10/4. The individual does not qualify for the denominator since the treatment period must be at least 91 days.
" + 'Statins are taken for the long-term therapeutic benefits which include decreased risk of cardiovascular events. These therapeutic regimens may not be present or useful at the end of life or for palliative care. As a result, individuals in hospice care are excluded from the PDC-STA measure.
Individuals with ESRD are excluded because evidence from major clinical trials has failed to demonstrate benefits for statin therapy in patients with ESRD.
The PDC calculation is appropriate for medication classes that are used on a routine basis and in which the days' supply can be accurately determined. For these reasons, our PDC measures are limited to medication classes used for chronic conditions (e.g., diabetes, hypertension, hypercholesterolemia) requiring on-going treatment and taken on a scheduled basis where days' supply and refills can be used to estimate medication use.
" + "Individuals with a proportion of days covered (PDC) of 80% or greater qualify for the numerator.
' + 'For this example, the individual is without medication from 6/30 through 9/24. With 365 days in the treatment period and only 278 days covered, the individual has a PDC of 76.16% which is less than the 80% threshold. Therefore, the individual should not be counted in the numerator.
' + 'A 2016 study by Bansilal and colleagues evaluated the association between medication adherence levels and major adverse cardiovascular events (MACE) or atherosclerotic disease (ATH) over two years. Claims data with 4,015 post-MI patients and 12,976 patients with ATH from a large US health insurance company was analyzed. In the post-MI cohort, fully -adherent (PDC ≥80%) patients had a significantly lower rate of MACE than non-adherent patients (18.9% vs. 26.3%; hazard ratio [HR]: 0.73; p=0.0004). In the ATH cohort, fully adherent patients (PDC ≥80%) had a significantly lower rate of MACE than non-adherent patients (8.42% vs. 17.17%; HR: 0.56; p<0.0001). This study showed PDC ≥80% adherence in the post-MI population was associated with a lower rate of MACE and ATH.
Another study by Korhonen and colleagues aimed to evaluate the relationship between statin adherence and ischemic stroke (IS) in patients with diabetes. A cohort of 52,868 statin initiators with diabetes (1995-2006) using Finnish health registers was evaluated. Good adherence to statins (PDC ≥80%) was associated with a 23% decreased incidence of IS (95% CI 14-32%) compared with poor adherence (PDC <80%). This association remained broadly unchanged when stratified by sex, age, history of atherosclerotic cardiovascular disease or IS. There was a dose-response relationship between adherence level and the risk of IS (RR 0.63 [0.53-0.75] for PDC ≥80% versus PDC <20%, p for trend <0.0001). Sensitivity analyses supported the robustness of the analysis.
Roebuck and colleagues in 2011 showed an increase in medication adherence (defined as the 80% threshold) reduced total annual health care spending primarily through decreased inpatient hospital days and emergency department visits. Regarding dyslipidemia, adherence decreased annual medical spending by $1,860 for a benefit-cost ratio of 3.1.
In 2014, Choudhry and colleagues conducted a retrospective analysis to evaluate the relationship between medication adherence (PDC ≥80%) and post-myocardial infarction adverse coronary events (N=4,117). Compared with patients randomized to usual care, patients who were adherent to statins, beta-blockers, and ACE/ARBs were significantly less likely to experience first major vascular event or revascularization (hazard ratio [HR] range, 0.64-0.81). In contrast, non-adherent patients showed no benefit (HR range, 0.98-1.04; P≤0.01 for the difference in HRs between adherent and non-adherent patients).
Similar findings were observed with statin adherence. In 2019 Chinthammit and colleagues evaluated the association of statin adherence (PDC ≥80%) with healthcare utilization and expenditures among commercially insured adults (N= 4,450,308). Adherence was associated with fewer inpatient visits (RR=0.746, 95% CI=0.739-0.753) and lower inpatient (CR=0.780, 95% CI=0.779-0.782) and total (CR=0.975, 95% CI=0.973-0.977) healthcare costs.
Yes. To calculate the PDC as a percentage, divide the number of covered days by the number of days and multiply by 100. The PDC should then be rounded to the nearest hundredth (e.g. 79.996% is rounded to 80.00%, 79.992% is rounded to 79.99%) before comparing to the threshold of 80%.
" + "If multiple prescription claims for the same target medication (i.e. one or more products with the same generic ingredient) are dispensed on the same day or different days where the days' supply overlap, adjust the prescription claim start date to be the day after the days' supply for previous prescription claim has ended.
" + "For this example, the individual's prescription claim on 3/25 overlaps with the days' supply for the prescription claim on 1/1. Because the prescription claims on 1/1 and 3/25 involve the same target drug, the start date for the prescription claim on 3/25 is adjusted to be the day after the days' supply for the prescription claim on 1/1 has ended. The same would apply for the prescription claim on 9/25 that overlaps with the days' supply for the prescription claim on 7/5.
" + 'For this example, the individual's prescription claim on 3/25 overlaps with the days' supply for the prescription claim on 1/1. However, because the prescription claims on 1/1 and 3/25 do not involve the same target drug, the start date for the prescription claim on 3/25 is not adjusted.
" + 'When there is overlap of a single agent and a combination product containing the same target drug (same generic ingredient) or when there is overlap of a combination product and another combination product with at least one of the target drugs (same generic ingredient) in common, adjust the prescription claim start date to be the day after the days' supply for previous prescription claim has ended.
" + "For this example, the individual's prescription claim on 3/25 overlaps with the days' supply for the prescription claim on 1/1. Because the prescription claim for the single ingredient product on 1/1 and the prescription claim for the combination product on 3/25 both include the same target drug, the start date for the prescription claim on 3/25 is adjusted to be the day after the days' supply for the prescription claim on 1/1 has ended.
" + 'These measures use administrative claims data, which do not contain the data elements needed to account for discontinuation of a medication. Even so, this should not disproportionately impact certain health plans.
" + "When calculating the PDC, individuals only need to be covered by one target medication for each day in the treatment period. The PDC calculation allows for switching between target medications (i.e. " + singleAgent1 + ", " + singleAgent2 + ") during the treatment period. The treatment period does not end for discontinuation of a medication. However, for overlapping prescriptions involving the same target medication (or single agent and combination products containing the same target medication), we adjust the prescription start date to be the day after the previous prescription claim has ended.
" + "For the Proportion of Days Covered: Diabetes All-Class Rate (PDC-DR) measure, individuals only need to be covered by one medication for each day in the treatment period. It does not need to be the same target medication (i.e. " + singleAgent1 + ", " + singleAgent2 + ") or class (i.e. biguanides, sulfonylureas) but does need to be on the target medication list.
" + "For this example, the individual is covered by several different medications during the treatment period. However, the individual is not covered by any single medication throughout the treatment period.
" + '