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Statin use up, but disparities remain
In the past 10 years, statin use has increased in the general adult population aged at least 40 years in the United States, but disparities and suboptimal uptake in higher-risk groups remain challenges, researchers reported.
Statin use was found to be significantly lower in women, racial/ethnic minorities and the uninsured in a retrospective longitudinal cohort study published in JAMA Cardiology.
According to Joseph A. Salami, MD, MPH, from the Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, and colleagues, overall total and out-of-pocket expenditures in the past decade associated with statin use in the United States adult population were found to have decreased.
“Using a set of nationally representative data, Salami and colleagues show that from 2002 to 2013, statin use increased substantially while out-of-pocket payments markedly decreased during a major shift toward generic drugs. All of this is good for the public health and for the individual. But they also report that statins are used suboptimally (ie, not high-intensity doses) in the highest-risk individuals; that women, racial/ethnic minorities, and the uninsured are all treated far less than might be expected based on their risk; and that despite the widespread availability of generic statins, 1 in 5 patients continue to use brand-name drugs and account for persistently high drug spending. Clearly all of these issues need to be addressed and improved on as we enter the fourth decade of statins as a foundational therapy of modern [CV] care,” Robert A. Harrington, MD, wrote in an editor’s note also published in JAMA Cardiology.
Statin use rose
Salami and colleagues obtained demographic, medical condition and medicine prescribing data on 157,000 adults aged at least 40 years from the Medical Expenditure Panel Survey database between 2002 and 2013. Trends in statin use, total expenditure and out-of-pocket expenditures were then estimated in the general population, in patients with established atherosclerotic CVD and in patients at risk for atherosclerotic CVD.
Statin use increased 79.8% in the general population from 2002-2003 to 2012-2013. Among patients with established atherosclerotic CVD, statin use increased from 49.8% in 2002-2003 to 58.1% in 2012-2013.
Statin use was found to be significantly lower in the following subgroups: women (OR = 0.81; 95% CI, 0.79-0.85); racial/ethnic minorities (OR = 0.65; 95% CI, 0.61-0.7); and the uninsured (OR = 0.33; 95% CI, 0.3-0.37). A significant increase was also seen in the proportion of generic statin use, which increased from 8.4% in 2002-2003 to 81.8% in 2012-2013.
“While total and [out-of-pocket] expenditures associated with statins decreased, further substitution of brand-name to generic statins may yield more savings,” Salami and colleagues wrote.
More work to be done
In a related editorial, William S. Weintraub, MD, from the Christiana Care Health System in Newark, Delaware, wrote of the findings: “Of import, statin use was significantly lower in women, racial/ethnic minorities and the uninsured. However, the proportion of generic statin use increased substantially. ... Furthermore, the gross domestic product–adjusted total cost for statins decreased from $17.2 billion (out-of-pocket cost, $6.9 billion) in 2002-2003 to $16.9 billion (out-of-pocket cost, $3.3 billion) in 2012-2013. The mean annual out-of-pocket costs for patients decreased from $280 to $94. The authors are to be congratulated for this clear, succinct and timely evaluation of statin use in the United States.
“The article by Salami et al provides good news concerning increasing use of statins, movement from patent-protected to generic statins, and decreasing costs. However, much needs to be done to achieve higher use in appropriate populations, increase adherence, reduce disparities, appropriately incorporate new therapies, address appropriateness of therapy in young people, and address how to provide care to all people around the world,” Weintraub wrote. – by Suzanne Reist
References:
Harrington RA. JAMA Cardiol. 2017;doi:10.1001/jamacardio.2016.4709.
Salami JA, et al. JAMA Cardiol. 2017;doi:10.1001/jamacardio.2016.4700.
Weintraub WS. JAMA Cardiol. 2017;doi:10.1001/jamacardio.2016.4710.
Disclosure : Harrington, Salami and Weintraub report no relevant financial disclosures. Please see the full study for a list of the other researchers’ relevant financial disclosures.