Did Australia's COVID-19 Restrictions Impact Statin Incidence, Prevalence or Adherence?

Abstract

COVID-19 restrictions may have an unintended consequence of limiting access to cardiovascular care. Australia implemented adaptive interventions (eg, telehealth consultations, digital image prescriptions, continued dispensing, medication delivery) to maintain medication access. This study investigated whether COVID-19 restrictions in different jurisdictions coincided with changes in statin incidence, prevalence and adherence. Analysis of a 10% random sample of national medication claims data from January 2018 to December 2020 was conducted across 3 Australian jurisdictions. Weekly incidence and prevalence were estimated by dividing the number statin initiations and any statin dispensing by the Australian population aged 18-99 years. Statin adherence was analyzed across the jurisdictions and years, with adherence categorized as <40%, 40%-79% and ≥80% based on dispensing per calendar year. Overall, 309,123, 315,703 and 324,906 people were dispensed and 39,029, 39,816, and 44,979 initiated statins in 2018, 2019, and 2020 respectively. Two waves of COVID-19 restrictions in 2020 coincided with no meaningful change in statin incidence or prevalence per week when compared to 2018 and 2019. Incidence increased 0.3% from 23.7 to 26.2 per 1000 people across jurisdictions in 2020 compared to 2019. Prevalence increased 0.14% from 158.5 to 159.9 per 1000 people across jurisdictions in 2020 compared to 2019. The proportion of adults with ≥80% adherence increased by 3.3% in Victoria, 1.4% in NSW and 1.8% in other states and territories between 2019 and 2020. COVID-19 restrictions did not coincide with meaningful changes in the incidence, prevalence or adherence to statins suggesting adaptive interventions succeeded in maintaining access to cardiovascular medications.

FIG 1

Incidence and prevalence of statin therapy 2018 to 2020. (A) Weekly count of people initiated on statin therapy in Victoria (VIC), New South Wales (NSW), and all other Australian states and territories (OTH). (B) Weekly count of the prevalence of statin therapy among people within VIC, NSW, and other states and territories. In each jurisdiction, the red line denotes the first wave of restrictions in Victoria commencing March 16, 2020, the green line denotes easing of restrictions on May 11, 2020, the blue line denotes the second wave of restrictions June 30, 2020, and the yellow line denotes easing of restrictions on October 26, 2020. (Color version of figure is available online.)

FIG 2

Annual statin adherence by jurisdiction in 2018-2020. Breakdown of low (0%-39%), moderate (40%-79%) and high (>=80%) to statin therapy within jurisdictions of Victoria (VIC), New South Wales (NSW), and all other Australian states and territories.(Color version of figure is available online.)