National trends in nonstatin use and expenditures among the US adult population from 2002 to 2013

Insights from medical expenditure panel survey

Joseph A. Salami, Haider J. Warraich, Javier Valero-Elizondo, Erica S. Spatz, Nihar R. Desai, Jamal S. Rana, Salim S. Virani, Ron Blankstein, Amit Khera, Michael Blaha, Roger S Blumenthal, Barry T. Katzen, Donald Lloyd-Jones, Harlan M. Krumholz, Khurram Nasir

Research output: Contribution to journalArticle

Abstract

Background--Evidence supporting nonstatin lipid-lowering therapy in atherosclerotic cardiovascular disease risk reduction is variable. We aim to examine nonstatin utilization and expenditures in the United States between 2002 and 2013. Methods and Results--We used the Medical Expenditure Panel Survey database to estimate national trends in nonstatin use and cost (total and out-of-pocket, adjusted to 2013 US dollars using a gross domestic product deflator) among adults 40 years or older. Nonstatin users increased from 3 million (2.5%) in 2002-2003 (20.1 million prescriptions) to 8 million (5.6%) in 2012-2013 (45.8 million prescriptions). Among adults with atherosclerotic cardiovascular disease, nonstatin use increased from 7.5% in 2002- 2003 to 13.9% in 2012-2013 after peaking at 20.3% in 2006-2007. In 2012-2013, 15.9% of high-intensity statin users also used nonstatins, versus 9.7% of low/moderate-intensity users and 3.6% of statin nonusers. Nonstatin use was significantly lower among women (odds ratio 0.80; 95% confidence interval 0.75-0.86), racial/ethnic minorities (odds ratio 0.41; 95% confidence interval 0.36-0.47), and the uninsured (odds ratio 0.47; 95% confidence interval 0.40-0.56). Total nonstatin expenditures increased from $1.7 billion (out-of-pocket cost, $ 0.7 billion) in 2002-2003 to $ 7.9 billion (out-of-pocket cost $ 1.6 billion) in 2012-2013, as peruser nonstatin expenditure increased from $550 to $ 992. Nonstatin expenditure as a proportion of all lipid-lowering therapy expenditure increased 4-fold from 8% to 32%. Conclusions--Between 2002 and 2013, nonstatin use increased by 124%, resulting in a 364% increase in nonstatin-associated expenditures.

Original languageEnglish (US)
Article numbere007132
JournalJournal of the American Heart Association
Volume7
Issue number2
DOIs
StatePublished - Jan 1 2018

Fingerprint

Health Expenditures
Population
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Odds Ratio
Confidence Intervals
Prescriptions
Cardiovascular Diseases
Surveys and Questionnaires
Gross Domestic Product
Lipids
Risk Reduction Behavior
Databases
Therapeutics

Keywords

  • Cardiovascular disease prevention
  • Cost
  • Health economics
  • Nonstatin
  • Statin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

National trends in nonstatin use and expenditures among the US adult population from 2002 to 2013 : Insights from medical expenditure panel survey. / Salami, Joseph A.; Warraich, Haider J.; Valero-Elizondo, Javier; Spatz, Erica S.; Desai, Nihar R.; Rana, Jamal S.; Virani, Salim S.; Blankstein, Ron; Khera, Amit; Blaha, Michael; Blumenthal, Roger S; Katzen, Barry T.; Lloyd-Jones, Donald; Krumholz, Harlan M.; Nasir, Khurram.

In: Journal of the American Heart Association, Vol. 7, No. 2, e007132, 01.01.2018.

Research output: Contribution to journalArticle

Salami, JA, Warraich, HJ, Valero-Elizondo, J, Spatz, ES, Desai, NR, Rana, JS, Virani, SS, Blankstein, R, Khera, A, Blaha, M, Blumenthal, RS, Katzen, BT, Lloyd-Jones, D, Krumholz, HM & Nasir, K 2018, 'National trends in nonstatin use and expenditures among the US adult population from 2002 to 2013: Insights from medical expenditure panel survey', Journal of the American Heart Association, vol. 7, no. 2, e007132. https://doi.org/10.1161/JAHA.117.007132
Salami, Joseph A. ; Warraich, Haider J. ; Valero-Elizondo, Javier ; Spatz, Erica S. ; Desai, Nihar R. ; Rana, Jamal S. ; Virani, Salim S. ; Blankstein, Ron ; Khera, Amit ; Blaha, Michael ; Blumenthal, Roger S ; Katzen, Barry T. ; Lloyd-Jones, Donald ; Krumholz, Harlan M. ; Nasir, Khurram. / National trends in nonstatin use and expenditures among the US adult population from 2002 to 2013 : Insights from medical expenditure panel survey. In: Journal of the American Heart Association. 2018 ; Vol. 7, No. 2.
@article{5448a7a9c05e40b9bbb26a6b1f56d8ad,
title = "National trends in nonstatin use and expenditures among the US adult population from 2002 to 2013: Insights from medical expenditure panel survey",
abstract = "Background--Evidence supporting nonstatin lipid-lowering therapy in atherosclerotic cardiovascular disease risk reduction is variable. We aim to examine nonstatin utilization and expenditures in the United States between 2002 and 2013. Methods and Results--We used the Medical Expenditure Panel Survey database to estimate national trends in nonstatin use and cost (total and out-of-pocket, adjusted to 2013 US dollars using a gross domestic product deflator) among adults 40 years or older. Nonstatin users increased from 3 million (2.5{\%}) in 2002-2003 (20.1 million prescriptions) to 8 million (5.6{\%}) in 2012-2013 (45.8 million prescriptions). Among adults with atherosclerotic cardiovascular disease, nonstatin use increased from 7.5{\%} in 2002- 2003 to 13.9{\%} in 2012-2013 after peaking at 20.3{\%} in 2006-2007. In 2012-2013, 15.9{\%} of high-intensity statin users also used nonstatins, versus 9.7{\%} of low/moderate-intensity users and 3.6{\%} of statin nonusers. Nonstatin use was significantly lower among women (odds ratio 0.80; 95{\%} confidence interval 0.75-0.86), racial/ethnic minorities (odds ratio 0.41; 95{\%} confidence interval 0.36-0.47), and the uninsured (odds ratio 0.47; 95{\%} confidence interval 0.40-0.56). Total nonstatin expenditures increased from $1.7 billion (out-of-pocket cost, $ 0.7 billion) in 2002-2003 to $ 7.9 billion (out-of-pocket cost $ 1.6 billion) in 2012-2013, as peruser nonstatin expenditure increased from $550 to $ 992. Nonstatin expenditure as a proportion of all lipid-lowering therapy expenditure increased 4-fold from 8{\%} to 32{\%}. Conclusions--Between 2002 and 2013, nonstatin use increased by 124{\%}, resulting in a 364{\%} increase in nonstatin-associated expenditures.",
keywords = "Cardiovascular disease prevention, Cost, Health economics, Nonstatin, Statin",
author = "Salami, {Joseph A.} and Warraich, {Haider J.} and Javier Valero-Elizondo and Spatz, {Erica S.} and Desai, {Nihar R.} and Rana, {Jamal S.} and Virani, {Salim S.} and Ron Blankstein and Amit Khera and Michael Blaha and Blumenthal, {Roger S} and Katzen, {Barry T.} and Donald Lloyd-Jones and Krumholz, {Harlan M.} and Khurram Nasir",
year = "2018",
month = "1",
day = "1",
doi = "10.1161/JAHA.117.007132",
language = "English (US)",
volume = "7",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - National trends in nonstatin use and expenditures among the US adult population from 2002 to 2013

T2 - Insights from medical expenditure panel survey

AU - Salami, Joseph A.

AU - Warraich, Haider J.

AU - Valero-Elizondo, Javier

AU - Spatz, Erica S.

AU - Desai, Nihar R.

AU - Rana, Jamal S.

AU - Virani, Salim S.

AU - Blankstein, Ron

AU - Khera, Amit

AU - Blaha, Michael

AU - Blumenthal, Roger S

AU - Katzen, Barry T.

AU - Lloyd-Jones, Donald

AU - Krumholz, Harlan M.

AU - Nasir, Khurram

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background--Evidence supporting nonstatin lipid-lowering therapy in atherosclerotic cardiovascular disease risk reduction is variable. We aim to examine nonstatin utilization and expenditures in the United States between 2002 and 2013. Methods and Results--We used the Medical Expenditure Panel Survey database to estimate national trends in nonstatin use and cost (total and out-of-pocket, adjusted to 2013 US dollars using a gross domestic product deflator) among adults 40 years or older. Nonstatin users increased from 3 million (2.5%) in 2002-2003 (20.1 million prescriptions) to 8 million (5.6%) in 2012-2013 (45.8 million prescriptions). Among adults with atherosclerotic cardiovascular disease, nonstatin use increased from 7.5% in 2002- 2003 to 13.9% in 2012-2013 after peaking at 20.3% in 2006-2007. In 2012-2013, 15.9% of high-intensity statin users also used nonstatins, versus 9.7% of low/moderate-intensity users and 3.6% of statin nonusers. Nonstatin use was significantly lower among women (odds ratio 0.80; 95% confidence interval 0.75-0.86), racial/ethnic minorities (odds ratio 0.41; 95% confidence interval 0.36-0.47), and the uninsured (odds ratio 0.47; 95% confidence interval 0.40-0.56). Total nonstatin expenditures increased from $1.7 billion (out-of-pocket cost, $ 0.7 billion) in 2002-2003 to $ 7.9 billion (out-of-pocket cost $ 1.6 billion) in 2012-2013, as peruser nonstatin expenditure increased from $550 to $ 992. Nonstatin expenditure as a proportion of all lipid-lowering therapy expenditure increased 4-fold from 8% to 32%. Conclusions--Between 2002 and 2013, nonstatin use increased by 124%, resulting in a 364% increase in nonstatin-associated expenditures.

AB - Background--Evidence supporting nonstatin lipid-lowering therapy in atherosclerotic cardiovascular disease risk reduction is variable. We aim to examine nonstatin utilization and expenditures in the United States between 2002 and 2013. Methods and Results--We used the Medical Expenditure Panel Survey database to estimate national trends in nonstatin use and cost (total and out-of-pocket, adjusted to 2013 US dollars using a gross domestic product deflator) among adults 40 years or older. Nonstatin users increased from 3 million (2.5%) in 2002-2003 (20.1 million prescriptions) to 8 million (5.6%) in 2012-2013 (45.8 million prescriptions). Among adults with atherosclerotic cardiovascular disease, nonstatin use increased from 7.5% in 2002- 2003 to 13.9% in 2012-2013 after peaking at 20.3% in 2006-2007. In 2012-2013, 15.9% of high-intensity statin users also used nonstatins, versus 9.7% of low/moderate-intensity users and 3.6% of statin nonusers. Nonstatin use was significantly lower among women (odds ratio 0.80; 95% confidence interval 0.75-0.86), racial/ethnic minorities (odds ratio 0.41; 95% confidence interval 0.36-0.47), and the uninsured (odds ratio 0.47; 95% confidence interval 0.40-0.56). Total nonstatin expenditures increased from $1.7 billion (out-of-pocket cost, $ 0.7 billion) in 2002-2003 to $ 7.9 billion (out-of-pocket cost $ 1.6 billion) in 2012-2013, as peruser nonstatin expenditure increased from $550 to $ 992. Nonstatin expenditure as a proportion of all lipid-lowering therapy expenditure increased 4-fold from 8% to 32%. Conclusions--Between 2002 and 2013, nonstatin use increased by 124%, resulting in a 364% increase in nonstatin-associated expenditures.

KW - Cardiovascular disease prevention

KW - Cost

KW - Health economics

KW - Nonstatin

KW - Statin

UR - http://www.scopus.com/inward/record.url?scp=85040905876&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85040905876&partnerID=8YFLogxK

U2 - 10.1161/JAHA.117.007132

DO - 10.1161/JAHA.117.007132

M3 - Article

VL - 7

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 2

M1 - e007132

ER -