Saudi Pharmaceutical Journal (Jun 2023)
Statins utilization trends and expenditures in the U.S. before and after the implementation of the 2013 ACC/AHA guidelines
Abstract
Importance: Statins are drugs of choice in treating hyperlipidemia and preventing or reducing cardiovascular diseases. Purpose: Explore statins utilization and expenditure trends in the United States before and after the publication of the 2013 ACC/AHA guidelines. Method: A retrospective, cross-sectional study of US noninstitutionalized civilians was conducted using MEPS data from 2008 to 2019. Adults who were ≥ 40 years old and who reported taking statins were included in the study. Primary outcomes: Statins use patterns, total cost, and out-of-pocket spending in the general adults who reported taking statins medications. Expenditures were expressed in 2019 US dollars. Results: In this study, 409,804 individuals were eligible to be included (mean age [SE], 59 [0.1] years; 54% female). Of those participants, 22% reported taking statin therapy, and 11% of them filled only one statin prescription. The number of individuals in the general population who reported taking any statin climbed from 31 million (12%) in 2008–2009 to 92 million (35%) in 2018–2019, representing a 197% increase. After 2013, the number of individuals who used statins increased by 149%, from 37 million in 2012–2013 to 92 million users in 2018–2019. The annual number of statins prescriptions increased from 461 million to 818 million (77%; p = 0.000) between 2008 and 2019. Atorvastatin was the most prescribed medication in the statins class (36%), followed by simvastatin (34%). The moderate-intensity statins were the most used by the participants (60%). The total statins cost in 2013 was $8 billion and increased to $10 billion in 2019 (25%; p = 0.000). The total OOP expenditure trend sloped from $4.0 billion in the 2008–2009 cycle to $3.1 billion in 2018–2019. The average OOP paid by Asians was higher than that of other races at $141. Conclusion: The proportion of individuals who used statins significantly increased following the adoption of the 2013 ACC/AHA guidelines. The findings, however, demonstrated suboptimal prescribing trends of high-intensity statins, which need to be addressed by the stakeholders to maximize medication outcomes. Statins expenditures, especially the co-payments, significantly decreased. The results have shown that revised or new regulations have a substantial impact on the healthcare industry.
