Growth in use of lipid-lowering therapies: are we targeting the right patients?
BACKGROUND
Prescription drug spending has been rising at > 10% per year, with volume of use (rather than price) being the primary driver for that growth. Concern exists that industry marketing has led to increased use of medications by patients with marginal indications.


OBJECTIVE
To determine whether the increase in the number of patients receiving lipid-lowering therapy represents a shift away from treatment of patients at highest cardiovascular (CV) risk towards patients in lower risk categories.


METHODS
Cardiovascular risk criteria adapted from guidelines were applied to an administrative database of medical and pharmaceutical claims for 1997 and 1999 that included managed care plan enrollees in 22 states. Patients were assigned to 1 of 7 categories representing CV risk based on documentation of CV disease/risk factors, with category 1 and 2 indicating the highest risk group (secondary prevention). The odds of the treated population being in the highest risk during 1997 versus 1999 were calculated, adjusting for age and sex.


RESULTS
Patients treated with lipid medications in the study population increased from 5% in 1997 to 8% in 1999. During the same period, the percentage of treated patients in categories 1 through 6 rose from 17% to 21%. The odds of the treated population being in the highest risk group did not differ significantly between the 2 years (odds ratio (OR) = 0.99; 95% confidence interval, (CI) 0.96-1.01; P = .40).


CONCLUSIONS
Despite an increase in the percentage of patients receiving lipid-lowering therapy from 1997 to 1999, treatment rates rose modestly across all categories. Greater overall use did not appear to be associated with a shift in use towards patients with less CV risk.
Dubois
Robert W
RW
Zynx Health, Inc., Beverly Hills, California 90212, USA. rdubois@cerner.com
Alexander
Charles M
CM
Wade
Sally
S
Mosso
Andrew
A
Markson
Leona
L
Lu
J D
JD
Nag
Soma
S
Berger
Marc L
ML
D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D015331:Cohort Studies; D017723:Drug Utilization Review; D005260:Female; D006302:Health Services Research; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D008329:Managed Care Programs; D020380:Needs Assessment; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
D000960:Hypolipidemic Agents