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J Am Heart Assoc. 2018 Jan 22;7(2). pii: e007132. doi: 10.1161/JAHA.117.007132.

National Trends in Nonstatin Use and Expenditures Among the US Adult Population From 2002 to 2013: Insights From Medical Expenditure Panel Survey.

Author information

1
Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL.
2
Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC.
3
Center for Outcomes Research and Evaluation, Yale New Haven Hospital & Section of Cardiovascular Medicine, Yale University, New Haven, CT.
4
Divisions of Cardiology and Research, Kaiser Permanente Northern California, Oakland, CA.
5
Michael E. DeBakley Veterans Affairs Medical Center & Section of Cardiology, Baylor College of Medicine, Houston, TX.
6
Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, MA.
7
Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
8
The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD.
9
Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL.
10
Department of Preventive Medicine & Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
11
Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL khurramn@baptisthealth.net.

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 per-user 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

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