Abstract 11575: Comparative Effectiveness of Generic Atorvastatin and Lipitor® in Patients Hospitalized With an Acute Coronary Syndrome
Bibliographic record
Abstract
Introduction: After generic atorvastatin became available in Canada in June 2010, Ontario’s public prescription benefit program mandated universal substitution of Lipitor® to generic atorvastatin to reduce expenditures. Although generic medications are approved based on bioequivalence with brand-name medications, there remains substantial concern about their clinical effectiveness and safety. This policy change afforded a unique opportunity to compare clinical outcomes between patients with acute coronary syndrome (ACS) prescribed generic atorvastatin and Lipitor®. Methods: We assembled a population-based cohort of patients ≥65 years, discharged alive after an ACS hospitalization between 2008-2012, who were prescribed generic atorvastatin or Lipitor® within 7 days of discharge. Propensity score-matching on demographics, comorbidities, medical and invasive treatment, and physician and hospital characteristics was used to adjust for confounding. The primary outcome was death or recurrent ACS hospitalization at 1-year. Secondary outcomes included hospitalization for heart failure, stroke, new-onset diabetes, rhabdomyolysis, and renal failure. Results: In the 7,863 matched pairs (15,726 patients) of ACS patients, mean age was 76.9 years, 56.3% were male, 87.6% had a myocardial infarction and 12% had unstable angina, and all patients had complete follow-up. At 1-year, 17.7% of those prescribed generic atorvastatin and 17.7% prescribed Lipitor® experienced death or recurrent ACS (HR:1.00, 95%CI 0.93-1.08, p=0.94). Pre-specified subgroup analyses by age, sex, diabetes, atorvastatin dose, admission diagnosis, or generic product also found no difference between groups. No significant differences in secondary outcomes, including side effects, between treatment groups were observed. Conclusions: Among older adults discharged alive after ACS hospitalization, we found no significant difference in cardiovascular outcomes or side effects in patients prescribed generic atorvastatin compared with those prescribed Lipitor® at 1 year. Our findings support the use of generic atorvastatin in ACS, which could lead to substantial cost saving for patients and healthcare plans without diminishing population clinical effectiveness.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".