title: Growth in use of lipid-lowering therapies: are we targeting the right patients?
abstract: 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.
authors.affiliation: Zynx Health, Inc., Beverly Hills, California 90212, USA. rdubois@cerner.com
authors.forename: Robert W
authors.initials: RW
authors.lastname: Dubois
authors.forename: Charles M
authors.initials: CM
authors.lastname: Alexander
authors.forename: Sally
authors.initials: S
authors.lastname: Wade
authors.forename: Andrew
authors.initials: A
authors.lastname: Mosso
authors.forename: Leona
authors.initials: L
authors.lastname: Markson
authors.forename: J D
authors.initials: JD
authors.lastname: Lu
authors.forename: Soma
authors.initials: S
authors.lastname: Nag
authors.forename: Marc L
authors.initials: ML
authors.lastname: Berger
mesh_terms: 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
chemical_list: D000960:Hypolipidemic Agents