Med Decis Making - Optimizing statin treatment decisions for diabetes patients in the presence of uncertain future adherence.


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CKGROUND: Statins are an important part of the treatment plan for patients with type 2 diabetes. However, patients who are prescribed statins often take less than the prescribed amount or stop taking the drug altogether. This suboptimal adherence may decrease the benefit of statin initiation.OBJECTIVE: To estimate the influence of adherence on the optimal timing of statin initiation for patients with type 2 diabetes.METHOD: The authors use a Markov decision process (MDP) model to optimize the treatment decision for patients with type 2 diabetes. Their model incorporates a Markov model linking adherence to treatment effectiveness and long-term health outcomes. They determine the optimal time of statin initiation that minimizes expected costs and maximizes expected quality-adjusted life years (QALYs).RESULTS: In the long run, approximately 25% of patients remain highly adherent to statins. Based on the MDP model, generic statins lower costs in men and result in a small increase in costs in women relative to no treatment. Patients are able to noticeably increase their expected QALYs by 0.5 to 2 years depending on the level of adherence.CONCLUSIONS: Adherence-improving interventions can increase expected QALYs by as much as 1.5 years. Given suboptimal adherence to statins, it is optimal to delay the start time for statins; however, changing the start time alone does not lead to significant changes in costs or QALYs.

Resumo Limpo

ckground statin import part treatment plan patient type diabet howev patient prescrib statin often take less prescrib amount stop take drug altogeth suboptim adher may decreas benefit statin initiationobject estim influenc adher optim time statin initi patient type diabetesmethod author use markov decis process mdp model optim treatment decis patient type diabet model incorpor markov model link adher treatment effect longterm health outcom determin optim time statin initi minim expect cost maxim expect qualityadjust life year qalysresult long run approxim patient remain high adher statin base mdp model generic statin lower cost men result small increas cost women relat treatment patient abl notic increas expect qali year depend level adherenceconclus adherenceimprov intervent can increas expect qali much year given suboptim adher statin optim delay start time statin howev chang start time alon lead signific chang cost qali

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