Dis I, Verschuren WM; Authors/Task Force Members. 2016 European. Guidelines on cardiovascular disease prevention in clin
Data Report Twenty-Year Nationwide Trends in Statin Utilization and Expenditure in Denmark Martin Bødtker Mortensen, MD, PhD; Erling Falk, MD, DMSc; Morten Schmidt, MD, PhD
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uring the past 20 years, numerous large randomized controlled trials have documented the efficacy and safety of statin therapy for both primary and secondary preventions of atherosclerotic cardiovascular disease.1 Accordingly, statin therapy constitutes the cornerstone of pharmacological prevention of atherosclerotic cardiovascular disease in all major international cholesterol guidelines.2,3 Statins are among the top-selling medications in both Europe and the United States, and the market for statin therapy is expected to grow as the population continues to age. In recent years, most statins have become available in generic versions with potentially great implications for their overall use and the associated costs to the healthcare system. Such information could provide important insights for European policy makers on healthcare value and future potential for improving cost-effectiveness of statin use. However, few previous studies have investigated national trends in statin use and costs, and none in a European country endorsing the guidelines issued by the European Society of Cardiology. We, therefore, examined nationwide 20-year trends in statin utilization and expenditure in Denmark.
statin expenditures. The expenditures were adjusted for price inflation assuming an annual inflation rate of 1.88% (average annual inflation of the Consumer Price Index in Denmark from 1996 to 2015). Additional information on Methods is provided in the Data Supplement.
Trends in Statin Utilization From 1996 to 2015, the overall use of statin therapy increased 62fold from 2.2 to 137.3 DDD per 1000 inhabitants (Figure [A]; Figure I and Table I in the Data Supplement). The increase in statin use was most pronounced in those aged >65 years (Figure II in the Data Supplement). Usage of the different types of statins changed considerably during the period studied and correlated well with introduction of generic versions (Figure [A] and [C]). From 1996 to 2012, the prescription of simvastatin (generic version introduced in 2002) increased from 1.2 DDD (55% of total statin use) to 86 DDD (74% of total statin use) per 1000 inhabitants, whereas the use thereafter decreased to 72 DDD per 1000 inhabitants in 2015 (53% of total statin use). The use of atorvastatin increased slowly from its release to the market in 1997 until 2012 when its generic version was introduced. After 2012, an abrupt increase was observed reaching 55 DDD in 2015 (40% of total statin use). Since its introduction in 2003, the use of rosuvastatin increased steadily from 0.2 DDD (1% of total statin use) to 9.4 DDD per 1000 inhabitants in 2015 (7% of total statin use). Use of the remaining statins combined (lovastatin, pravastatin, fluvastatin, and cerivastatin) reached a maximum of 3.2 DDD in 2002 (21% of total statin use), decreasing thereafter to reach 1.1 DDD in 2015 (
