National trends in statin use and expenditures in the US adult population from 2002 to 2013: Insights From the Medical Expenditure Panel Survey

Joseph A. Salami, Haider 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, Donald Lloyd-Jones, Khurram Nasir

Research output: Contribution to journalArticle

Abstract

IMPORTANCE: Statins remain a mainstay in the prevention and treatment of atherosclerotic cardiovascular disease (ASCVD). OBJECTIVE: To detail the trends in use and total and out-of-pocket (OOP) expenditures associated with statins in a representative US adult population from 2002 to 2013. DESIGN, SETTING, AND PARTICIPANTS: This retrospective longitudinal cohort study was conducted from January 2002 to December 2013. Demographic, medical condition, and prescribed medicine information of adults 40 years and older between 2002 and 2013 were obtained from the Medical Expenditure Panel Survey database. MAIN OUTCOMES AND MEASURES: Estimated trends in statin use, total expenditure, and OOP share among the general adult population, those with established ASCVD, and those at risk for ASCVD. Costs were adjusted to 2013 US dollars using the Gross Domestic Product Index. RESULTS: From 2002 to 2013, more than 157 000 Medical Expenditure Panel Survey participants were eligible for the study (mean [SD] age, 57.7 [39.9] years; 52.1% female). Overall, statin use among US adults 40 years of age and older in the general population increased 79.8% from 21.8 million individuals (17.9%) in 2002-2003 (134 million prescriptions) to 39.2 million individuals (27.8%) in 2012-2013 (221 million prescriptions). Among those with established ASCVD, statin use was 49.8% and 58.1% in 2002-2003 and 2012-2013, respectively, and less than one-third were prescribed as a high-intensity dose. Across all subgroups, statin use was significantly lower in women (odds ratio, 0.81; 95% CI, 0.79-0.85), racial/ethnic minorities (odds ratio, 0.65; 95% CI, 0.61-0.70), and the uninsured (odds ratio, 0.33; 95% CI, 0.30-0.37). The proportion of generic statin use increased substantially, from 8.4% in 2002-2003 to 81.8% in 2012-2013. Gross domestic product-adjusted total cost for statins decreased from $17.2 billion (OOP cost, $7.6 billion) in 2002-2003 to $16.9 billion (OOP cost, $3.9 billion) in 2012-2013, and the mean annual OOP costs for patients decreased from $348 to $94. Brand-name statins were used by 18.2% of statin users, accounting for 55% of total costs in 2012-2013. CONCLUSION AND RELEVANCE: Statin use increased substantially in the last decade among US adults, although the uptake was suboptimal in high-risk groups. While total and OOP expenditures associated with statins decreased, further substitution of brand-name to generic statins may yield more savings.

Original languageEnglish (US)
Pages (from-to)56-65
Number of pages10
JournalJAMA Cardiology
Volume2
Issue number1
DOIs
StatePublished - Jan 1 2017

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Health Expenditures
Population
Cardiovascular Diseases
Gross Domestic Product
Odds Ratio
Costs and Cost Analysis
Surveys and Questionnaires
Names
Prescriptions
Longitudinal Studies

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

National trends in statin use and expenditures in the US adult population from 2002 to 2013 : Insights From the Medical Expenditure Panel Survey. / Salami, Joseph A.; Warraich, Haider; Valero-Elizondo, Javier; Spatz, Erica S.; Desai, Nihar R.; Rana, Jamal S.; Virani, Salim S.; Blankstein, Ron; Khera, Amit; Blaha, Michael; Blumenthal, Roger S; Lloyd-Jones, Donald; Nasir, Khurram.

In: JAMA Cardiology, Vol. 2, No. 1, 01.01.2017, p. 56-65.

Research output: Contribution to journalArticle

Salami, JA, Warraich, H, Valero-Elizondo, J, Spatz, ES, Desai, NR, Rana, JS, Virani, SS, Blankstein, R, Khera, A, Blaha, M, Blumenthal, RS, Lloyd-Jones, D & Nasir, K 2017, 'National trends in statin use and expenditures in the US adult population from 2002 to 2013: Insights From the Medical Expenditure Panel Survey', JAMA Cardiology, vol. 2, no. 1, pp. 56-65. https://doi.org/10.1001/jamacardio.2016.4700
Salami, Joseph A. ; Warraich, Haider ; Valero-Elizondo, Javier ; Spatz, Erica S. ; Desai, Nihar R. ; Rana, Jamal S. ; Virani, Salim S. ; Blankstein, Ron ; Khera, Amit ; Blaha, Michael ; Blumenthal, Roger S ; Lloyd-Jones, Donald ; Nasir, Khurram. / National trends in statin use and expenditures in the US adult population from 2002 to 2013 : Insights From the Medical Expenditure Panel Survey. In: JAMA Cardiology. 2017 ; Vol. 2, No. 1. pp. 56-65.
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abstract = "IMPORTANCE: Statins remain a mainstay in the prevention and treatment of atherosclerotic cardiovascular disease (ASCVD). OBJECTIVE: To detail the trends in use and total and out-of-pocket (OOP) expenditures associated with statins in a representative US adult population from 2002 to 2013. DESIGN, SETTING, AND PARTICIPANTS: This retrospective longitudinal cohort study was conducted from January 2002 to December 2013. Demographic, medical condition, and prescribed medicine information of adults 40 years and older between 2002 and 2013 were obtained from the Medical Expenditure Panel Survey database. MAIN OUTCOMES AND MEASURES: Estimated trends in statin use, total expenditure, and OOP share among the general adult population, those with established ASCVD, and those at risk for ASCVD. Costs were adjusted to 2013 US dollars using the Gross Domestic Product Index. RESULTS: From 2002 to 2013, more than 157 000 Medical Expenditure Panel Survey participants were eligible for the study (mean [SD] age, 57.7 [39.9] years; 52.1{\%} female). Overall, statin use among US adults 40 years of age and older in the general population increased 79.8{\%} from 21.8 million individuals (17.9{\%}) in 2002-2003 (134 million prescriptions) to 39.2 million individuals (27.8{\%}) in 2012-2013 (221 million prescriptions). Among those with established ASCVD, statin use was 49.8{\%} and 58.1{\%} in 2002-2003 and 2012-2013, respectively, and less than one-third were prescribed as a high-intensity dose. Across all subgroups, statin use was significantly lower in women (odds ratio, 0.81; 95{\%} CI, 0.79-0.85), racial/ethnic minorities (odds ratio, 0.65; 95{\%} CI, 0.61-0.70), and the uninsured (odds ratio, 0.33; 95{\%} CI, 0.30-0.37). The proportion of generic statin use increased substantially, from 8.4{\%} in 2002-2003 to 81.8{\%} in 2012-2013. Gross domestic product-adjusted total cost for statins decreased from $17.2 billion (OOP cost, $7.6 billion) in 2002-2003 to $16.9 billion (OOP cost, $3.9 billion) in 2012-2013, and the mean annual OOP costs for patients decreased from $348 to $94. Brand-name statins were used by 18.2{\%} of statin users, accounting for 55{\%} of total costs in 2012-2013. CONCLUSION AND RELEVANCE: Statin use increased substantially in the last decade among US adults, although the uptake was suboptimal in high-risk groups. While total and OOP expenditures associated with statins decreased, further substitution of brand-name to generic statins may yield more savings.",
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T1 - National trends in statin use and expenditures in the US adult population from 2002 to 2013

T2 - Insights From the Medical Expenditure Panel Survey

AU - Salami, Joseph A.

AU - Warraich, Haider

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 - Lloyd-Jones, Donald

AU - Nasir, Khurram

PY - 2017/1/1

Y1 - 2017/1/1

N2 - IMPORTANCE: Statins remain a mainstay in the prevention and treatment of atherosclerotic cardiovascular disease (ASCVD). OBJECTIVE: To detail the trends in use and total and out-of-pocket (OOP) expenditures associated with statins in a representative US adult population from 2002 to 2013. DESIGN, SETTING, AND PARTICIPANTS: This retrospective longitudinal cohort study was conducted from January 2002 to December 2013. Demographic, medical condition, and prescribed medicine information of adults 40 years and older between 2002 and 2013 were obtained from the Medical Expenditure Panel Survey database. MAIN OUTCOMES AND MEASURES: Estimated trends in statin use, total expenditure, and OOP share among the general adult population, those with established ASCVD, and those at risk for ASCVD. Costs were adjusted to 2013 US dollars using the Gross Domestic Product Index. RESULTS: From 2002 to 2013, more than 157 000 Medical Expenditure Panel Survey participants were eligible for the study (mean [SD] age, 57.7 [39.9] years; 52.1% female). Overall, statin use among US adults 40 years of age and older in the general population increased 79.8% from 21.8 million individuals (17.9%) in 2002-2003 (134 million prescriptions) to 39.2 million individuals (27.8%) in 2012-2013 (221 million prescriptions). Among those with established ASCVD, statin use was 49.8% and 58.1% in 2002-2003 and 2012-2013, respectively, and less than one-third were prescribed as a high-intensity dose. Across all subgroups, statin use was significantly lower in women (odds ratio, 0.81; 95% CI, 0.79-0.85), racial/ethnic minorities (odds ratio, 0.65; 95% CI, 0.61-0.70), and the uninsured (odds ratio, 0.33; 95% CI, 0.30-0.37). The proportion of generic statin use increased substantially, from 8.4% in 2002-2003 to 81.8% in 2012-2013. Gross domestic product-adjusted total cost for statins decreased from $17.2 billion (OOP cost, $7.6 billion) in 2002-2003 to $16.9 billion (OOP cost, $3.9 billion) in 2012-2013, and the mean annual OOP costs for patients decreased from $348 to $94. Brand-name statins were used by 18.2% of statin users, accounting for 55% of total costs in 2012-2013. CONCLUSION AND RELEVANCE: Statin use increased substantially in the last decade among US adults, although the uptake was suboptimal in high-risk groups. While total and OOP expenditures associated with statins decreased, further substitution of brand-name to generic statins may yield more savings.

AB - IMPORTANCE: Statins remain a mainstay in the prevention and treatment of atherosclerotic cardiovascular disease (ASCVD). OBJECTIVE: To detail the trends in use and total and out-of-pocket (OOP) expenditures associated with statins in a representative US adult population from 2002 to 2013. DESIGN, SETTING, AND PARTICIPANTS: This retrospective longitudinal cohort study was conducted from January 2002 to December 2013. Demographic, medical condition, and prescribed medicine information of adults 40 years and older between 2002 and 2013 were obtained from the Medical Expenditure Panel Survey database. MAIN OUTCOMES AND MEASURES: Estimated trends in statin use, total expenditure, and OOP share among the general adult population, those with established ASCVD, and those at risk for ASCVD. Costs were adjusted to 2013 US dollars using the Gross Domestic Product Index. RESULTS: From 2002 to 2013, more than 157 000 Medical Expenditure Panel Survey participants were eligible for the study (mean [SD] age, 57.7 [39.9] years; 52.1% female). Overall, statin use among US adults 40 years of age and older in the general population increased 79.8% from 21.8 million individuals (17.9%) in 2002-2003 (134 million prescriptions) to 39.2 million individuals (27.8%) in 2012-2013 (221 million prescriptions). Among those with established ASCVD, statin use was 49.8% and 58.1% in 2002-2003 and 2012-2013, respectively, and less than one-third were prescribed as a high-intensity dose. Across all subgroups, statin use was significantly lower in women (odds ratio, 0.81; 95% CI, 0.79-0.85), racial/ethnic minorities (odds ratio, 0.65; 95% CI, 0.61-0.70), and the uninsured (odds ratio, 0.33; 95% CI, 0.30-0.37). The proportion of generic statin use increased substantially, from 8.4% in 2002-2003 to 81.8% in 2012-2013. Gross domestic product-adjusted total cost for statins decreased from $17.2 billion (OOP cost, $7.6 billion) in 2002-2003 to $16.9 billion (OOP cost, $3.9 billion) in 2012-2013, and the mean annual OOP costs for patients decreased from $348 to $94. Brand-name statins were used by 18.2% of statin users, accounting for 55% of total costs in 2012-2013. CONCLUSION AND RELEVANCE: Statin use increased substantially in the last decade among US adults, although the uptake was suboptimal in high-risk groups. While total and OOP expenditures associated with statins decreased, further substitution of brand-name to generic statins may yield more savings.

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