Impact of restricted reimbursement on the use of statins in Finland: a register-based study.
OBJECTIVE
New and expensive medicines are a driving force behind growth in medicine costs, and policies promoting use of less expensive products have been widely introduced. This study investigated the short-term consequences of the restricted reimbursement of expensive statins (atorvastatin and rosuvastatin) on the use of statins in Finland.


METHODS
Data on patients purchasing atorvastatin, rosuvastatin, or simvastatin in 2002-2007 were retrieved from the nationwide Prescription Register. Outcome measures included the time trend in the numbers of purchasers and initiators of different statins, the morbidities of new users before and after the new policy, and the proportion of users of expensive statins switching to other statins.


RESULTS
After the restriction, the numbers of purchasers of atorvastatin and rosuvastatin dropped, and atorvastatin and rosuvastatin were seldom prescribed as first-line therapy. Before the restriction, 20.9% of new users of atorvastatin and 18.4% of those of rosuvastatin had either coronary artery disease or familial hyperlipidemia. After the restriction the corresponding figures were 28.7% and 26.8%. After the restriction new users of atorvastatin and rosuvastatin were also more likely to use other cardiovascular medicines or antidiabetics or to have previous statin purchases. A total of 57.6% of those using atorvastatin and 49.2% of those using rosuvastatin before the restriction switched to a less expensive statin.


CONCLUSIONS
Restricted reimbursement of expensive statins decreased their use. It seems that after the policy new statin treatments have channeled appropriately. Although it is likely that the cost-containment aim of the policy was reached, health and long-term effects are not known.
Martikainen
Jaana E
JE
Research Department, The Social Insurance Institution, Helsinki, Finland. jaana.martikainen@kela.fi
Saastamoinen
Leena K
LK
Korhonen
Maarit J
MJ
Enlund
Hannes
H
Helin-Salmivaara
Arja
A
D000069059:Atorvastatin; D005260:Female; D005387:Finland; D005464:Fluorobenzenes / Q000191:economics* / Q000627:therapeutic use; D006291:Health Policy; D006538:Heptanoic Acids / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011743:Pyrimidines / Q000191:economics* / Q000627:therapeutic use; D011758:Pyrroles / Q000191:economics* / Q000627:therapeutic use; D012042:Registries; D012051:Reimbursement Mechanisms / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D000068718:Rosuvastatin Calcium; D013449:Sulfonamides / Q000191:economics* / Q000627:therapeutic use
D005464:Fluorobenzenes; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011743:Pyrimidines; D011758:Pyrroles; D013449:Sulfonamides; D000068718:Rosuvastatin Calcium; D000069059:Atorvastatin