title: Trends in Statin Use in Seniors 1999 to 2013: Time Series Analysis.
abstract: OBJECTIVE
  To examine HMG-CoA reductase inhibitor (statin) drug dispensing patterns to Nova Scotia Seniors' Pharmacare program (NSSPP) beneficiaries over a 14-year period in response to: 1) rosuvastatin market entry in 2003, 2) JUPITER trial publication in 2008, and 3) generic atorvastatin availability in 2010.
  
  
  METHODS
  All NSSPP beneficiaries who redeemed at least one prescription for a statin from April 1, 1999 to March 31, 2013 were included. Aggregated, anonymous monthly prescription counts were extracted by the Nova Scotia Department of Health and Wellness (Nova Scotia, Canada) and changes in dispensing patterns of statins were measured. Data were analyzed using descriptive analyses and interrupted time series methods.
  
  
  RESULTS
  The percentage of NSSPP beneficiaries dispensed any statin increased from 5.3% in April 1999 to 20.7% in March 2013. In 1999, most NSSPP beneficiaries were dispensed either simvastatin (29.5%) or atorvastatin (28.7%). When rosuvastatin was added to the NSSPP Formulary in August 2003, prescriptions dispensed for simvastatin, lovastatin, pravastatin, and fluvastatin declined significantly (slope change, -0.0027; 95% confidence interval (CI), (-0.0046, -0.0009)). This significant decline continued following the publication of JUPITER (level change, -0.1974; 95% CI, (-0.2991, -0.0957)) and the availability of generic atorvastatin (level change, -0.2436; 95% CI, (-0.3314, -0.1558)). Atorvastatin was not significantly affected by any of the three interventions, although it maintained an overall decreasing trend. Only upon the availability of generic atorvastatin did the upward trend in rosuvastatin use decrease significantly (slope change, -0.0010, 95% CI, (-0.0015, -0.0005)).
  
  
  CONCLUSIONS
  The type and rate of statins dispensed to NSSPP beneficiaries changed from 1999 to 2013 in response to the availability of new agents and publication of the JUPITER trial. The overall proportion of NSSPP beneficiaries dispensed a statin increased approximately 4-fold during the study period. In 2013, rosuvastatin was the most commonly dispensed statin (44.1%) followed by atorvastatin (39.1%).
authors.affiliation: College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Laura V
authors.identifier: http://orcid.org/0000-0002-1545-3470
authors.initials: LV
authors.lastname: Minard
authors.affiliation: Statistical Consulting Unit, Acadia University, Wolfville, Nova Scotia, Canada.
authors.forename: Amber
authors.initials: A
authors.lastname: Corkum
authors.affiliation: College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Sketris
authors.affiliation: Nova Scotia Department of Health and Wellness, Halifax, Nova Scotia, Canada.
authors.forename: Judith
authors.initials: J
authors.lastname: Fisher
authors.affiliation: Statistical Consulting Unit, Acadia University, Wolfville, Nova Scotia, Canada.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Saleh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000069059:Atorvastatin / Q000600:supply & distribution / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D005229:Fatty Acids, Monounsaturated / Q000600:supply & distribution / Q000627:therapeutic use; D005260:Female; D000077340:Fluvastatin; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000600:supply & distribution / Q000627:therapeutic use*; D000960:Hypolipidemic Agents / Q000600:supply & distribution / Q000627:therapeutic use*; D007211:Indoles / Q000600:supply & distribution / Q000627:therapeutic use; D065186:Interrupted Time Series Analysis; D008148:Lovastatin / Q000600:supply & distribution / Q000627:therapeutic use; D008297:Male; D009674:Nova Scotia; D017035:Pravastatin / Q000600:supply & distribution / Q000627:therapeutic use; D055553:Prescription Drugs / Q000600:supply & distribution / Q000627:therapeutic use*; D012189:Retrospective Studies; D000068718:Rosuvastatin Calcium / Q000600:supply & distribution / Q000627:therapeutic use; D019821:Simvastatin / Q000600:supply & distribution / Q000627:therapeutic use
chemical_list: D005229:Fatty Acids, Monounsaturated; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D007211:Indoles; D055553:Prescription Drugs; D000077340:Fluvastatin; D000068718:Rosuvastatin Calcium; D008148:Lovastatin; D000069059:Atorvastatin; D019821:Simvastatin; D017035:Pravastatin