title: Use of fibrates in the United States and Canada.
abstract: BACKGROUND
  Interest in the role of fibrates intensified after the publication of the negative results from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, which assessed therapy with fenofibrate plus statins. The evidence for clinical benefit in outcomes with the use of fibrates is heavily weighted on the use of the older fibrates such as gemfibrozil and clofibrate.
  
  
  OBJECTIVE
  To examine trends in the current use of fibrates and to examine the relationship between differences in the availability and use of brand-name vs generic formulations of fenofibrate and the economic implications in the United States compared with Canada.
  
  
  METHODS
  Population-level, observational cohort study using IMS Health data from the United States and Canada of patients prescribed fibrates between January 2002 and December 2009.
  
  
  METHODS
  Fibrate prescriptions dispensed and expenditures.
  
  
  RESULTS
  In the United States, fibrate prescriptions dispensed increased from 336 prescriptions/100,000 population in January 2002 to 730 prescriptions/100,000 population in December 2009, an increase of 117.1% (95% confidence interval [CI], 116.0%-117.9%), whereas in Canada, fibrate prescriptions increased from 402 prescriptions/100,000 population in January 2002 to 474 prescriptions/100,000 population in December 2009, an increase of 18.1% (95% CI, 17.9%-18.3%) (P <.001). In the United States, fenofibrate prescriptions dispensed increased from 150 prescriptions/100,000 population in January 2002 to 440 prescriptions/100,000 population in December 2009, an increase of 159.3% (95% CI, 157.7%-161.0%), comprising 47.9% of total fibrate prescriptions in 2002 and 65.2% in 2009. In Canada, fenofibrate prescriptions increased from 321 prescriptions/100,000 population in January 2002 to 429 prescriptions/100,000 population in December 2009. The annual ratio of generic to brand-name fenofibrate use in the United States ranged from 0:1 to 0.09:1 between 2002 and 2008, while the ratio in Canada steadily increased from 0.51:1 to 1.89:1 between 2005 and 2008. In the United States, crude fenofibrate expenditures increased from $11,535/100,000 population/month in 2002 to $44,975/100,000 population/month in 2009, while the rates in Canada declined from $17,695/100,000 population/month in 2002 to $16,112/100,000 population/month in 2009. Fibrate expenditures per 100,000 population were 3-fold higher in 2009 in the United States compared with Canada.
  
  
  CONCLUSIONS
  During the past decade, prescriptions for fibrates (particularly fenofibrate) increased in the United States, while prescriptions for fibrates in Canada remained stable.
authors.affiliation: Department of Pharmacy Practice and Administration, Western University of Health Sciences, College of Pharmacy, 309 E Second St, Pomona, CA 91766, USA. cjackevicius@westernu.edu
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Jackevicius
authors.forename: Jack V
authors.initials: JV
authors.lastname: Tu
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Ross
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Ko
authors.forename: Daniel
authors.initials: D
authors.lastname: Carreon
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D002170:Canada; D002318:Cardiovascular Diseases / Q000517:prevention & control; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D016527:Drug Costs; D016568:Drugs, Generic / Q000627:therapeutic use; D011345:Fenofibrate / Q000191:economics / Q000627:therapeutic use*; D058607:Fibric Acids / Q000191:economics / Q000627:therapeutic use*; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000191:economics / Q000627:therapeutic use*; D008485:Medical Audit; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D055656:Prescriptions / Q000706:statistics & numerical data; D014481:United States
chemical_list: D016568:Drugs, Generic; D058607:Fibric Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D011345:Fenofibrate