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MEDICATION COMPLIANCE TO STATIN THERAPY AND ITS
IMPACT ON DISEASE OUTCOMES IN TYPE 2 DIABETES
by
Lihua Zhang
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(PHARMACEUTICAL ECONOMICS AND POLICY)
May 2007
Copyright 2007 Lihua Zhang
Object Description
| Title | Medication compliance to statin therapy and its impact on disease outcomes in type 2 diabetes |
| Author | Zhang, Lihua |
| Author email | lihuazha@usc.edu |
| Degree | Doctor of Philosophy |
| Document type | Dissertation |
| Degree program | Pharmaceutical Economics & Policy |
| School | School of Pharmacy |
| Date defended/completed | 2007-03-30 |
| Date submitted | 2007 |
| Restricted until | Unrestricted |
| Date published | 2007-04-24 |
| Advisor (committee chair) | Nichol, Michael B. |
| Advisor (committee member) |
Buchanan, Thomas Ahn, Jeonghoon |
| Abstract | Objective: To examine long-term patient compliance to statin therapy in type 2 diabetes and its impact on various disease outcomes.; Methods: The California Medicaid program (Medi-Cal) claims data collected during the period of January 1995 to December 2004 was analyzed. Medication compliance was measured using Proportion of Days Covered (PDC) in each quarter of the study period. Descriptive analyses were performed to: 1) understand the trend of statin therapy in type 2 diabetes; 2) examine patient compliance to statin therapy and its change over time; and 3) compare long-term medication compliance to statin and to antidiabetic agents. A marginal structural model was employed to examine the impact of medication compliance to statin therapy on cardiovascular events. The effects of compliance on hospitalization and total medical costs were estimated by generalized estimating equations (GEE).; Results: Statin therapy was initiated earlier in patients with type 2 diabetes. Patient compliance to statin therapy was high (PDC=0.83, SD=0.234) during the first quarter of statin treatment. However, patient compliance dropped sharply from the second quarter (PDC=0.63, SD=0.382) and the medication compliance at the end of the first year of the treatment was decreased to 0.56. Over the 30 quarters, patients were less likely to comply with statin therapy than with antidiabetic treatment (approximately 35% difference). Hispanic patients and patients with complicated medication regimens were more likely to exhibit poor compliance to statin therapy. Compliance to statin therapy was significantly associated with decreased cardiovascular risk events (hazard ratio = 0.24; p<0.01) and less hospitalization in patients with type 2 diabetes (p<0.01).; Conclusion: Prescribing of statins in diabetic populations has improved in recent years, but long-term medication compliance to statin therapy and antidiabetic medications in the California Medicaid population remains problematic. |
| Keyword | statin; medication compliance; cardiovascular risk; costs; hospitalization; type 2 diabetes |
| Geographic subject (state) | California |
| Geographic subject (country) | USA |
| Language | English |
| Part of collection | University of Southern California dissertations and theses |
| Publisher (of the original version) | University of Southern California |
| Place of publication (of the original version) | Los Angeles, California |
| Publisher (of the digital version) | University of Southern California. Libraries |
| Type | texts |
| Legacy record ID | usctheses-m458 |
| Rights | Zhang, Lihua |
| Repository name | Libraries, University of Southern California |
| Repository address | Los Angeles, California |
| Repository email | http://www.usc.edu/isd/libraries/services/ask_a_librarian/email/ |
| Filename | etd-Zhang-20070424 |
| Archival file | uscthesesreloadpub_Volume26/etd-Zhang-20070424.pdf |
Description
| Title | Page 1 |
| Full text | MEDICATION COMPLIANCE TO STATIN THERAPY AND ITS IMPACT ON DISEASE OUTCOMES IN TYPE 2 DIABETES by Lihua Zhang A Dissertation Presented to the FACULTY OF THE GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY (PHARMACEUTICAL ECONOMICS AND POLICY) May 2007 Copyright 2007 Lihua Zhang |
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