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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.

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



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.


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%.


Between 2002 and 2013, nonstatin use increased by 124%, resulting in a 364% increase in nonstatin-associated expenditures.


Cardiovascular disease prevention; cost; health economics; nonstatin; statin

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