Improving Adherence With Genetic Awareness

Oct 1, 2013
Patients who were tested and informed about their KIF6 gene were 13% more likely to be adherent to cholesterol-lowering medications.

An Express Scripts study recently published in The Pharmacogenomics Journal shows that pharmacogenetic testing may improve a patient’s medication adherence to statin therapy, a significant barrier to successfully controlling high cholesterol.

Adherence Problem for High Cholesterol Patients

According to our 2012 Drug Trend Report, drugs used to treat high cholesterol have the second highest spend per member per year among all disease states. They also have a nonadherence rate of 27%.

With statin therapy, medication nonadherence is largely behavioral. High cholesterol is an asymptomatic condition, so many patients forget to take their medication or mistakenly believe that they only need to use a statin when they eat an unhealthy meal.

Despite the numerous strategies used to improve adherence, no approach has used direct communication of genetic test results to the patient as an adherence motivator.

The Role of KIF6 in Heart Disease

KIF6 is a gene that makes a protein involved in moving things around inside the body’s cells. Some research suggests that patients with one variant in the KIF6 gene may derive greater efficacy from statin therapy; however, more research is needed to more closely examine this relationship.

Genetic testing is available to see if an individual carries the KIF6 gene. While we don’t know for certain yet if the KIF6 variant predicts a person’s risk for heart disease and his response to statins, we sought to learn how this information could affect patient behavior relating to statin therapy.

Research-Driven Solution

Express Scripts' researchers examined the medication adherence of 1,294 patients who were newly prescribed statins. The laboratory-developed KIF6 gene test was provided to half the patients, while the remaining half in the control group did not receive a genetic test.

The two groups were matched for age, gender, prescription distribution channel and the number of chronic medications used. The study also controlled for other patient characteristics known to affect adherence such as comorbidities and socioeconomic status.

Awareness Increased Adherence by 13%

Measuring the proportion of days with the medication on-hand over a six-month period, researchers discovered that 77% of patients informed about the results of their KIF6 gene test adhered to their statin regimen, versus 68% who were not tested.

In addition, tested patients were 83% more likely to stay on their statin medication for the full six months.

Knowledge Leads to Greater Health Outcomes

Our research has shown that 69% of medication nonadherence can be attributed to procrastination and forgetfulness. What this study tells us is that information about a person’s genetic makeup could be a powerful motivator that leads to better health decisions. While more research is needed to better understand the relationship between genetic testing and adherence, this research sheds lights on more ways Express Scripts can better engage with patients to drive improved health outcomes.

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