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Original Investigation
January 2017

National Trends in Statin Use and Expenditures in the US Adult Population From 2002 to 2013Insights From the Medical Expenditure Panel Survey

Author Affiliations
  • 1Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami
  • 2Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina
  • 3Center for Outcomes Research and Evaluation, Yale New Haven Hospital and Section of Cardiovascular Medicine, Yale University, New Haven, Connecticut
  • 4Divisions of Cardiology and Research, Kaiser Permanente Northern California, Oakland
  • 5Michael E. DeBakey Veterans Affairs Medical Center and Section of Cardiology, Baylor College of Medicine, Houston, Texas
  • 6Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
  • 7Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas
  • 8The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland
  • 9Department of Preventive Medicine, Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
  • 10Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida
JAMA Cardiol. 2017;2(1):56-65. doi:10.1001/jamacardio.2016.4700
Key Points

Question  What are the trends in statin use and expenditure in the US adult population?

Findings  This cohort study found that statin use among adults 40 years and older increased from 17.9% in 2002-2003 to 27.8% in 2012-2013, with significantly lower use among women, racial/ethnic minorities, and the uninsured. The gross domestic product–adjusted total cost for statins decreased from $17.2 billion (out-of-pocket cost, $7.6 billion) to $16.9 billion (out-of-pocket cost, $3.9 billion), with brand-name statins accounting for 55% of total costs in 2012-2013.

Meaning  In the US adult population, while statin use increased substantially over the last decade, disparities and suboptimal uptake in higher-risk groups, along with significant costs, persisted in this time frame.

Abstract

Importance  Statins remain a mainstay in the prevention and treatment of atherosclerotic cardiovascular disease (ASCVD).

Objective  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.

Design, Setting, and Participants  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.

Main Outcomes and Measures  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.

Results  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.

Conclusion and Relevance  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.

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