Analysis of a medical aid administrator database for costs and utilisation of benefits by patients claiming for lipid-lowering agents.

OBJECTIVE: This is a descriptive study to analyse overall costs of medical scheme beneficiaries using lipid-lowering agents. The purpose of the analysis was to relate claims for lipid-lowering agents to utilisation and costs of drugs and services.

METHODS: An analysis was undertaken of physician visits, cardiac-related disease co-morbidities and hospitalisation. Any medication or dose changes were also analysed, including those after hospitalisation.

RESULTS: A total of 100 691 patients were identified, clustered around the age groups of 40 to 70 years, of whom 60% were males. The cohort consisted ethnically mainly of whites (68%), with an even distribution (6-9%) of Asian, black and Coloured subjects. Of these patients, approximately a third had recorded co-morbidities, mainly hypertension (58.6%) and the more prevalent cardiovascular (ischaemic heart disease, coronary artery disease) and metabolic disorders. While drug costs accounted for approximately 28% of total costs, hospitalisation cost (66%) was by far the greatest cost driver. Whereas drug costs appeared to have decreased over the period of analysis, hospitalisation costs had increased dramatically. Patients appeared to be stable on initial prescribed drug therapy with a relatively low incidence of switching (< 25%), mainly to the generic, simvastatin. Adherence to statin therapy was remarkably high at 85%.

CONCLUSIONS: Despite the manifold shortcomings, mainly due to the lack of ICD10 coding and information on critical clinical parameters, the study gives some brief insights into the burden of managing patients with cardiovascular diseases and provides a basis for improving future studies.