Abstract
PurposeTo 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.MethodsAll 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.ResultsThe 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)).ConclusionsThe 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%).
Highlights
The use of HMG-CoA reductase inhibitor drugs in the population is increasing with cumulative global sales estimated to approach $1 trillion by 2020 [1]
The percentage of Nova Scotia Seniors’ Pharmacare Program (NSSPP) beneficiaries dispensed any statin increased from 5.3% in April 1999 to 20.7% in March 2013
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))
Summary
The use of HMG-CoA reductase inhibitor (statin) drugs in the population is increasing with cumulative global sales estimated to approach $1 trillion by 2020 [1]. In Canada, statins are one of the fastest growing drug classes with expenditures increasing from $0.5 billion in 1998 to $1.9 billion (Canadian) in 2007 [2]. There are currently six different statins on the Canadian market; all are available as generic formulations. JUPITER (Justification for the Use of statins in primary Prevention: an Intervention Trial Evaluating Rosuvastatin) was an RCT that examined the effect of rosuvastatin on the occurrence of the combined end point of myocardial infarction (MI), stroke, arterial revascularization, hospitalization for unstable angina, or death from cardiovascular causes among apparently healthy men and women without hyperlipidemia, but with elevated high-sensitivity C-reactive protein levels [8,9]. At the time of JUPITER publication, rosuvastatin was available only as brand name Crestor
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