麻豆传媒

Anyone reading this is almost certainly aware of the enormous importance of statins in the current health scene. But until now they may have had a hard time to bring precise numbers and statistics to this all important story.

Now data from a large federal survey confirm that the billions of dollars spent on these drugs have not been distributed evenly across the U.S. population. In particular, huge subgroups -- women, minorities, the uninsured -- were significantly less likely than white men to receive statin therapy.

In , Joseph Salami, MD, MPH, of Baptist Health South Florida in Miami, and colleagues analyzed data from 2002 to 2013 from the Medical Expenditure Panel Survey (MEPS), a national survey sponsored by the Agency for Healthcare Research and Quality.

The study provides what is likely the best available information relating to statin use and costs in the 21st century.

"While the recent introduction of generic statins has led to a decrease in the cost of statins, to our knowledge, trends of the intensity or expenditures on statins have not been robustly examined," they wrote. "In this study, we analyzed the ... data to delineate trends in statin use and costs."

Despite their enormous growth and broad acceptance, statins remain underutilized in certain key groups, the study shows, while some may argue that statins are overused in other populations. Further, the data also suggests that even as statins became available as inexpensive generic versions billions of dollars were spent each year on more expensive versions of the drugs.

Some of the key findings of the study:

• Statin use steadily increased from 13.4% to 22.2% among those without ASCVD, 33.4% to 52.7% among those with diabetes, and 28.1% to 47.0% among those with hyperlipidemia and not diabetes over the 12-year period.
• The number of adults who take statins increased by 79.8% from 2002-2003 to 2012-2013, from 21.8 million, or 17.9% of the population, to 39.2 million, or 27.8% of the population.
• The odds ratio for statin use among women during the study period, relative to men, was 0.81 (95% CI 0.79-0.85).
• Among people without established heart disease statin use jumped from 13.4% to 22.2%; among those with diabetes, from 33.4% to 52.7%; and among nondiabetics with hyperlipidemia from 28.1% to 47.0%.
• The number of statin prescriptions written each year increased by 65%, from 134 million to 221 million.
• Brand-name statins were used by 19.9 million adults, accounting for 91.6% of all prescriptions at the start of the study. This dropped to 7.8 million adults, accounting for 18.2% of all prescriptions, by the end. At this point 31.4 million adults took generic statins.
• The most commonly prescribed statins were atorvastatin until 2006-2007, when it was then replaced by simvastatin.
• Annual total expenditures for statins were $17.2 billion in 2002-2003, reached a peak in 2008-2009 at $22 billion, and dropped in 2012-2013 to $16.9 billion.

In an interview, co-author Khurram Nassir, MD, MPH, also of Baptist Health South Florida, said that a big concern is the fact that women, minority groups and the uninsured were significantly less likely to use statins. "Even if you take into account differences in access to healthcare, such as insurance, these disparities still exist," he said. "If you are an African American you are almost 50% less likely to get a statin, even if you have cardiovascular disease."

He added that "the question remains how are we going to acknowledge this and deal with it."

Nassir also focused on the fact that among high risk populations, including those with known cardiovascular disease, only 60% are taking statins, and less than one-third of statin users are using the highest dose. "Shouldn't we increase access in the highest risk group before considering the higher cost of alternatives like PCSK9 inhibitors," he asked.

Comment