Trends in prescribing and utilization of statins and other lipid lowering drugs across Europe 1997–2003

Abstract

Aims To describe trends in utilization and prescribing of statins and other lipid lowering drugs across Europe from data in routine administrative databases. Methods Observational study in EU member states and Norway. Comparison of annual utilization data for lipid lowering agents by class and drug from national administrative databases for reimbursement over the period 1997–2003, measured in DDDs per 1000 inhabitants/day. Prescribed daily doses (PDD) of statins obtained from a commercial database (IMS Health) for 2000 and 2003, and used to calculate numbers of ‘patient treatment days’ (PTD) in each country in each year. Analysis of PTD to explain increased utilization of statins. Results Use of lipid lowering agents varied among countries (in 2003, highest in Ireland and Norway, and lowest in Italy), but increased in all countries studied (between 2000 and 2003 by 274% in Ireland and by 56% in France). This increase was entirely due to increases in statin use. Prescribed daily doses of statins increased in all countries for which data was available between 2000 and 2003, but still usually fell below the doses used in the major trials of statins. As a result, the numbers of PTDs increased to a lesser extent than suggested by utilization (e.g. by 192% in Ireland and by 35% in France). One‐third of the total rise in utilization was explained by increased PDD, and two‐thirds by an increase in numbers of PTDs. Statins dominated the markets in all countries, although fibrates remained strong in France and Belgium (approximately 25% of all lipid lowering agents) and to a lesser extent Germany (10%). Conclusions Use of statins across Europe has increased hugely over the study period. Some of the increase in use is due to higher prescribed daily doses, but two‐thirds is due to increases in numbers of patient days of treatment, either due to more patients treated or less likely to better compliance.

Differences in utilization rates between commercial and administrative databases: implications for future health-economic and cross-national studies

“…for the PPIs and statins, these can be explained by the specific policies in Lithuania (Table 1). Interestingly, the differences seen for the statins between the various databases (Table 3) were much greater than seen in previous studies across Europe [1,19], which shows the value of additional research. Not surprisingly, there was convergence in utilization rates between the databases once the reimbursement restrictions were lifted for the statins (Tables 1 and 2) in view of the prevalence of CHD in Lithuania [15].…”

“…National and cross national comparative (CNC) drug utilization studies provide valuable information to policy makers to plan future measures to further enhance the quality and efficiency of their prescribing [1][2][3][4][5]. Data sources for drug utilization (DU) studies include administrative databases, patient registries, electronic health records, and commercial databases [2,6].…”

Co‐medication of statins and CYP3A4 inhibitors before and after introduction of new reimbursement policy

“…A European study from 2003 indicated that Norway had the highest statin consumption per inhabitant in Europe [17]. Due to the substantial costs related to statin use, a new reimbursement policy was introduced by the Norwegian Medicines Agency in June 2005 [18], stating that all patients requiring statins should be prescribed simvastatin as first-line therapy.…”

Use of FAO food balance sheets to estimate the potential ability of novel folate-enriched eggs to increase the folate supply in European Union countries

“…Although these recommendations have been questioned because of the fact that dietary cholesterol has much less of an influence on plasma cholesterol than total fat and especially saturated and trans fat (70,71) , the general public is unaware of this and may tend to regard all high-cholesterol foods, D e n m a r k E s t o n i a F i n l a n d F r a n c e G e r m a n y G r e e c e H u n g a r y I r e l a n d I t a l y L a t v i a L i t h u a n i a M a l t a N e t h e r l a n d s P o l a n d P o r t u g a l R o m a n i a S l o v a k i a S l o v e n i a S p a i n S w e d e n U K Per capita folate supply from eggs including eggs, with suspicion. This situation may be exacerbated by the high-profile marketing of novel cholesterol-lowering foods, the recent EU approval of a cholesterol-related health claim for plant sterols and stanols (72) and by the increased tendency for doctors to prescribe statin drugs to aggressively lower serum cholesterol (73) . Thus, it may be difficult to persuade the general public to increase egg consumption appreciably regardless of the purported health benefits.…”