title: National Trends in Statin Use and Expenditures in the US Adult Population From 2002 to 2013: Insights From the Medical Expenditure Panel Survey.
abstract: Statins remain a mainstay in the prevention and treatment of atherosclerotic cardiovascular disease (ASCVD).
  
  
  
  To detail the trends in use and total and out-of-pocket (OOP) expenditures associated with statins in a representative US adult population from 2002 to 2013.
  
  
  
  This retrospective longitudinal cohort study was conducted from January 2002 to December 2013. Demographic, medical condition, and prescribed medicine information of adults 40 years and older between 2002 and 2013 were obtained from the Medical Expenditure Panel Survey database.
  
  
  
  Estimated trends in statin use, total expenditure, and OOP share among the general adult population, those with established ASCVD, and those at risk for ASCVD. Costs were adjusted to 2013 US dollars using the Gross Domestic Product Index.
  
  
  
  From 2002 to 2013, more than 157 000 Medical Expenditure Panel Survey participants were eligible for the study (mean [SD] age, 57.7 [39.9] years; 52.1% female). Overall, statin use among US adults 40 years of age and older in the general population increased 79.8% from 21.8 million individuals (17.9%) in 2002-2003 (134 million prescriptions) to 39.2 million individuals (27.8%) in 2012-2013 (221 million prescriptions). Among those with established ASCVD, statin use was 49.8% and 58.1% in 2002-2003 and 2012-2013, respectively, and less than one-third were prescribed as a high-intensity dose. Across all subgroups, statin use was significantly lower in women (odds ratio, 0.81; 95% CI, 0.79-0.85), racial/ethnic minorities (odds ratio, 0.65; 95% CI, 0.61-0.70), and the uninsured (odds ratio, 0.33; 95% CI, 0.30-0.37). The proportion of generic statin use increased substantially, from 8.4% in 2002-2003 to 81.8% in 2012-2013. Gross domestic product-adjusted total cost for statins decreased from $17.2 billion (OOP cost, $7.6 billion) in 2002-2003 to $16.9 billion (OOP cost, $3.9 billion) in 2012-2013, and the mean annual OOP costs for patients decreased from $348 to $94. Brand-name statins were used by 18.2% of statin users, accounting for 55% of total costs in 2012-2013.
  
  
  
  Statin use increased substantially in the last decade among US adults, although the uptake was suboptimal in high-risk groups. While total and OOP expenditures associated with statins decreased, further substitution of brand-name to generic statins may yield more savings.
authors.affiliation: Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Salami
authors.affiliation: Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Haider
authors.initials: H
authors.lastname: Warraich
authors.affiliation: Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami.
authors.forename: Javier
authors.initials: J
authors.lastname: Valero-Elizondo
authors.affiliation: Center for Outcomes Research and Evaluation, Yale New Haven Hospital and Section of Cardiovascular Medicine, Yale University, New Haven, Connecticut.
authors.forename: Erica S
authors.initials: ES
authors.lastname: Spatz
authors.affiliation: Center for Outcomes Research and Evaluation, Yale New Haven Hospital and Section of Cardiovascular Medicine, Yale University, New Haven, Connecticut.
authors.forename: Nihar R
authors.initials: NR
authors.lastname: Desai
authors.affiliation: Divisions of Cardiology and Research, Kaiser Permanente Northern California, Oakland.
authors.forename: Jamal S
authors.initials: JS
authors.lastname: Rana
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center and Section of Cardiology, Baylor College of Medicine, Houston, Texas.
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
authors.affiliation: Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
authors.affiliation: Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas.
authors.forename: Amit
authors.initials: A
authors.lastname: Khera
authors.affiliation: The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.affiliation: The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland.
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.affiliation: Department of Preventive Medicine, Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Donald
authors.initials: D
authors.lastname: Lloyd-Jones
authors.affiliation: Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami8The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland10Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida.
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000188:drug therapy* / Q000191:economics; D002318:Cardiovascular Diseases / Q000191:economics / Q000517:prevention & control*; D011307:Drug Prescriptions / Q000191:economics; D016568:Drugs, Generic / Q000627:therapeutic use; D005260:Female; D005102:Health Expenditures / Q000639:trends*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D016568:Drugs, Generic; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors