Cost Of Statins Research Articles

Abstract PO2-02-04: The Impact of Statins on Breast Cancer Specific Mortality in a Diverse Patient Population with Stage I-III Hormone Receptor Positive, HER2 Negative Breast Cancer

Abstract Hormone receptor-positive (HR+), HER2 negative (HER2−) breast cancer has a long-term risk of recurrence, compared with other breast cancer subtypes, which ultimately impacts mortality outcomes. Although adjuvant endocrine therapy plays an integral role in risk reduction, disparities persist—with Black women experiencing higher mortality rates compared to White women. Multiple studies have demonstrated that statin use can lead to a reduction in breast cancer mortality, but there is limited information in relation to the impact of statins among diverse patient populations in the United States. To assess whether statin use is associated with an improvement in breast cancer-specific mortality (BCSM), we conducted a large, observational study in women aged 66 and older diagnosed with Stage I–IIIC HR+, HER2- breast cancer between 2013 and 2017. We identified eligible women using the SEER-Medicare database and linked them to the BRIDGE (BReast cancer Investigation of Disparities in GEorgia) cohort, a survivorship cohort of the Georgia Cancer Registry. Patients needed to be continuously enrolled in Medicare Parts A, B, and D in the 12 months following a breast cancer diagnosis. We used Cox proportional hazards models to estimate the impact of statin use within 12 months of diagnosis on BCSM with adjustment for age, stage, and race using multivariable-adjusted hazard ratios (HRs). A total of 2483 participants were identified, and of those, 303 (12.2%) were statin users, 383 (15.4%) were non-Hispanic Black women, and 1564 (63%) resided in census tract with greater than or equal to 10% poverty levels at the time of diagnosis. Distribution of age, stage, and race were similar between statin and non-statin users. Of the statin users, 41/303 (13.5%) were non-Hispanic Black women. The majority of statin users were prescribed lipophilic statins alone (169; 55.8%), and atorvastatin was the most commonly prescribed statin. There was no association between statin use and BCSM (HR 1.09; 95% CI 0.62-1.90) in the multivariable-adjusted model. Although preliminary results suggest that there is no association between statin use and BCSM among women with Stage I–IIIC HR+, HER2− breast cancer, further analyses are planned to explore statin use as a time-varying exposure, which may provide additional insights into the potential relationship between statin use and BCSM. In addition, analyses examining potential heterogeneity by race, tumor and treatment characteristics, and comorbidities are forthcoming. Given the low cost and relative accessibility of statins, we anticipate these findings will inform the clinical management of women with operable breast cancer, increasing parity in outcomes and potentially narrowing race disparities. Citation Format: Ruth Sacks, Maya Bliss, Micah Streiff, Leah Moubadder, Maret Maliniak, Tsion Armidie, Lindsay Collin, Kevin Kalinsky, Lauren McCullough. The Impact of Statins on Breast Cancer Specific Mortality in a Diverse Patient Population with Stage I-III Hormone Receptor Positive, HER2 Negative Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-02-04.

Measuring Costs of Cardiovascular Disease Prevention for Patients with Familial Hypercholesterolemia in Administrative Claims Data.

Familial hypercholesterolemia is a common genetic condition that significantly increases an individual's risk of cardiovascular events such as heart attack, stroke, and cardiac death and is a candidate for population-wide screening programs. Economic analyses of strategies to identify and treat familial hypercholesterolemia are limited by a lack of real-world cost estimates for screening services and medications for reducing cardiovascular risk in this population. We estimated the cost of lipid panel testing in patients with hyperlipidemia and the cost of statins, ezetimibe, and PCKS9 inhibitors in patients with familial hypercholesterolemia from a commercial claims database and report costs and charges per panel and prescription by days' supply. The mean cost for a 90-day supply for statins was $183.33, 2.3 times the mean cost for a 30-day supply at $79.35. PCSK9 inhibitors generated the highest mean costs among medications used by patients with familial hypercholesterolemia. Lipid testing and lipid-lowering medications for cardiovascular disease prevention generate substantial real-world costs which can be used to improve cost-effectiveness models of familial hypercholesterolemia screening and care management.

Statins utilization trends and expenditures in the U.S. before and after the implementation of the 2013 ACC/AHA guidelines

ImportanceStatins are drugs of choice in treating hyperlipidemia and preventing or reducing cardiovascular diseases. PurposeExplore statins utilization and expenditure trends in the United States before and after the publication of the 2013 ACC/AHA guidelines. MethodA retrospective, cross-sectional study of US noninstitutionalized civilians was conducted using MEPS data from 2008 to 2019. Adults who were ≥ 40 years old and who reported taking statins were included in the study. Primary outcomesStatins use patterns, total cost, and out-of-pocket spending in the general adults who reported taking statins medications. Expenditures were expressed in 2019 US dollars. ResultsIn this study, 409,804 individuals were eligible to be included (mean age [SE], 59 [0.1] years; 54% female). Of those participants, 22% reported taking statin therapy, and 11% of them filled only one statin prescription. The number of individuals in the general population who reported taking any statin climbed from 31 million (12%) in 2008–2009 to 92 million (35%) in 2018–2019, representing a 197% increase. After 2013, the number of individuals who used statins increased by 149%, from 37 million in 2012–2013 to 92 million users in 2018–2019. The annual number of statins prescriptions increased from 461 million to 818 million (77%; p = 0.000) between 2008 and 2019. Atorvastatin was the most prescribed medication in the statins class (36%), followed by simvastatin (34%). The moderate-intensity statins were the most used by the participants (60%). The total statins cost in 2013 was $8 billion and increased to $10 billion in 2019 (25%; p = 0.000). The total OOP expenditure trend sloped from $4.0 billion in the 2008–2009 cycle to $3.1 billion in 2018–2019. The average OOP paid by Asians was higher than that of other races at $141. ConclusionThe proportion of individuals who used statins significantly increased following the adoption of the 2013 ACC/AHA guidelines. The findings, however, demonstrated suboptimal prescribing trends of high-intensity statins, which need to be addressed by the stakeholders to maximize medication outcomes. Statins expenditures, especially the co-payments, significantly decreased. The results have shown that revised or new regulations have a substantial impact on the healthcare industry.

Cost-effectiveness of statin therapy in categories of patients in the UK

Abstract Background Cardiovascular disease (CVD) mortality has declined steadily over the last few decades across Europe and North America. Purpose To provide contemporary estimates of long-term effectiveness and cost-effectiveness of statin therapy in different categories of patients in UK. Methods The CTT-UKB micro-simulation model, developed using the Cholesterol Treatment Trialists' Collaboration data (CTT: 118,000 participants; 5 years follow-up), and calibrated in the UK Biobank cohort (UKB: 502,000 participants; 9 years follow-up). The model integrates parametric risk equations for incident myocardial infarction, stroke, coronary revascularization, diabetes, cancer and vascular and nonvascular death, and projects annually these endpoints and survival using patient characteristics at entry. UKB data and linked primary and hospital care data informed healthcare costs in the model (2020 UK£); 2021 UK NHS Drug Tariff informed statin costs (atorvastatin 40mg at £1.22 and 80mg at £1.68 per 28 tablets); and Health Survey for England data informed health-related quality of life in the model. Previous CTT meta-analysis, atorvastatin dose-response randomized trials, and further meta-analyses of statin trials and cohort studies informed effects of 40mg/80mg atorvastatin therapy daily on rates of incident myocardial infarction, stroke, coronary revascularization, vascular death, diabetes, myopathy and rhabdomyolysis. The model was used to project gains in quality-adjusted life years (QALYs) and additional cost per QALY with lifetime use of atorvastatin 40mg or 80mg daily in categories of UKB participants by sex, age at statin initiation (40–49; 50–59 and 60–70 years), and 10-year CVD risk (QRISK3 risk (%): <5; 5–10, 10–15, 15–20, ≥20). Further scenarios explored effects of 5-year delay of statin initiation in people under 45 years of age or stopping statin therapy at 80 years of age. Results Across men and women in categories by age and CVD risk, lifetime use of atorvastatin 40mg daily was associated with increases in survival by 0.44–1.69 years (0.28–1.02 QALYs), and atorvastatin 80mg daily with increases in survival of 0.45–1.87 years (0.32–1.13 QALYs; Figure 1) with gains larger among participants at higher CVD risk. Both atorvastatin 40mg and 80mg doses were in the range of cost-effective treatments with incremental cost per QALY gained with atorvastatin 40mg daily versus no statin therapy below £7200/QALY and with atorvastatin 80mg vs 40mg daily below £16000/QALY (Figure 2) across all patient categories studied. Compared to lifetime statin therapy, stopping therapy at 80 years of age substantially reduced benefits and was not cost-effective in any patient category studied. Similarly, compared to immediate initiation, 5-year delay of statin therapy in 40–45 years old patients was not a cost-effective. Conclusions In the UK, statin therapy remains highly cost-effective across men and women 40–70 years old, including those at 10-year CVD risk <5%. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): UK National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme, UK National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme, UK Medical Research Council (MRC), British Heart Foundation

Considering whether countries participating in clinical trials can afford the intervention.

... Clinical trials often recruit from a diverse array of countries to help researchers understand the generalizability of their intervention. The economic circumstances in participating countries may vary substantially. This raises the issue of whether the intervention, even if proven to be effective and cost-effective in wealthy countries, would be cost-effective among resource-limited participant countries. It is only fair that states who help establish an intervention benefit from that intervention immediately after the trial concludes and over an extended period. However, this may be difficult to achieve, particularly for interventions that are inexpensive and exhibit small absolute health gains (cost-effectiveness ratios are generally easier to improve upon for expensive and/or highly effective interventions). Here, we provide an example. It is well established that HIV infection, even when well treated, increases the risk of atherosclerotic cardiovascular disease (ASCVD; Shah et al., 2018). In 2015, a large clinical trial, the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE), was launched to test the effectiveness of statins for primary prevention of ASCVD in people living with HIV (PLHIV) at low to moderate risk of cardiovascular disease based on an assessment of traditional risk factors (ClinicalTrials.gov, 2020). Generic statins cost <$1 per day in most parts of the world and typically reduce ASCVD incidence by between 10% and 30% (Cholesterol Treatment Trialists’ Collaborators, 2012). Estimates of primary ASCVD incidence in the current HIV population range from 3 to 6 per 1000 person-years (Friis-Moller et al., 2016; Boettiger et al., 2020). REPRIEVE has now recruited 7770 participants from 11 countries, 9 of which are classified as low- or middle-income (The World Bank, 2020). The results are expected in 2023.

Cost-effectiveness of statins for primary prevention of atherosclerotic cardiovascular disease among people living with HIV in the United States.

BackgroundExpanding statin use may help to alleviate the excess burden of atherosclerotic cardiovascular disease in people living with HIV (PLHIV). Pravastatin and pitavastatin are preferred agents due to their lack of substantial interaction with antiretroviral therapy. We aimed to evaluate the cost‐effectiveness of pravastatin and pitavastatin for the primary prevention of atherosclerotic cardiovascular disease among PLHIV in the United States.MethodsWe developed a microsimulation model that randomly selected (with replacement) individuals from the Data‐collection on Adverse Effects of Anti‐HIV Drugs study with follow‐up between 2013 and 2016. Our study population was PLHIV aged 40 to 75 years, stable on antiretroviral therapy, and not currently using lipid‐lowering therapy. Direct medical costs and quality‐adjusted life‐years (QALYs) were assigned in annual cycles and discounted at 3% per year. We assumed a willingness‐to‐pay threshold of $100,000/QALY gained. The interventions assessed were as follows: (1) treating no one with statins; (2) treating everyone with generic pravastatin 40 mg/day (drug cost $236/year) and (3) treating everyone with branded pitavastatin 4 mg/day (drug cost $2,828/year). The model simulated each individual’s probability of experiencing atherosclerotic cardiovascular disease over 20 years.ResultsPersons receiving pravastatin accrued 0.024 additional QALYs compared with those not receiving a statin, at an incremental cost of $1338, giving an incremental cost‐effectiveness ratio of $56,000/QALY gained. Individuals receiving pitavastatin accumulated 0.013 additional QALYs compared with those using pravastatin, at an additional cost of $18,251, giving an incremental cost‐effectiveness ratio of $1,444,000/QALY gained. These findings were most sensitive to the pill burden associated with daily statin administration, statin costs, statin efficacy and baseline atherosclerotic cardiovascular disease risk. In probabilistic sensitivity analysis, no statin was optimal in 5.2% of simulations, pravastatin was optimal in 94.8% of simulations and pitavastatin was never optimal.ConclusionsPravastatin was projected to be cost‐effective compared with no statin. With substantial price reduction, pitavastatin may be cost‐effective compared with pravastatin. These findings bode well for the expanded use of statins among PLHIV in the United States. To gain greater confidence in our conclusions it is important to generate strong, HIV‐specific estimates on the efficacy of statins and the quality‐of‐life burden associated with taking an additional daily pill.

Teaching Old Drugs New Tricks: Statins for COVID-19?

The COVID-19 pandemic has driven unprecedented efforts to identify existing treatments that can be quickly and effectively repurposed to reduce morbidity and mortality. In this issue of Cell Metabolism, Zhang et al. (2020) report an association between statin use and improved outcomes in a large observational study of hospitalized COVID-19 patients. Given the widespread availability, low cost, and safety of statins, this promising result should be further investigated in randomized controlled trials.

Statins for atherosclerotic cardiovascular disease prevention in people living with HIV in Thailand: a cost-effectiveness analysis.

IntroductionPeople living with HIV (PLHIV) have an elevated risk of atherosclerotic cardiovascular disease (CVD) compared to their HIV‐negative peers. Expanding statin use may help alleviate this burden. However, the choice of statin in the context of antiretroviral therapy is challenging. Pravastatin and pitavastatin improve cholesterol levels in PLHIV without interacting substantially with antiretroviral therapy. They are also more expensive than most statins. We evaluated the cost‐effectiveness of pravastatin and pitavastatin for the primary prevention of CVD among PLHIV in Thailand who are not currently using lipid‐lowering therapy.MethodsWe developed a discrete‐state microsimulation model that randomly selected (with replacement) individuals from the TREAT Asia HIV Observational Database cohort who were aged 40 to 75 years, receiving antiretroviral therapy in Thailand, and not using lipid‐lowering therapy. The model simulated each individual’s probability of experiencing CVD. We evaluated: (1) treating no one with statins; (2) treating everyone with pravastatin 20mg/day (drug cost 7568 Thai Baht ($US243)/year) and (3) treating everyone with pitavastatin 2 mg/day (drug cost 8182 Baht ($US263)/year). Direct medical costs and quality‐adjusted life‐years (QALYs) were assigned in annual cycles over a 20‐year time horizon and discounted at 3% per year. We assumed the Thai healthcare sector perspective.ResultsPravastatin was estimated to be less effective and less cost‐effective than pitavastatin and was therefore dominated (extended) by pitavastatin. Patients receiving pitavastatin accumulated 0.042 additional QALYs compared with those not using a statin, at an extra cost of 96,442 Baht ($US3095), giving an incremental cost‐effectiveness ratio of 2,300,000 Baht ($US73,812)/QALY gained. These findings were sensitive to statin costs and statin efficacy, pill burden, and targeting of PLHIV based on CVD risk. At a willingness‐to‐pay threshold of 160,000 Baht ($US5135)/QALY gained, we estimated that pravastatin would become cost‐effective at an annual cost of 415 Baht ($US13.30)/year and pitavastatin would become cost‐effective at an annual cost of 600 Baht ($US19.30)/year.ConclusionsNeither pravastatin nor pitavastatin were projected to be cost‐effective for the primary prevention of CVD among PLHIV in Thailand who are not currently using lipid‐lowering therapy. We do not recommend expanding current use of these drugs among PLHIV in Thailand without substantial price reduction.

Analysis of cost variation among various statin preparations available in India

Introduction: Hyperlipidemias are recognized as one of the major risk factors for the development of Coronary Artery Disease (CAD). Statins are the most potent lipid lowering agents currently available that significantly lower the morbidity and mortality associated with CAD. Aim: To compare the cost of various statins of different brands by calculating the percentage variation of cost. Materials and Methods: Prices of different statin preparations per 10 tablets/ capsules in rupees were reviewed from Drug today April-June 2018 issue and www.drugsupdate.com for analysis. Maximum and minimum price difference of the same drug manufactured by different pharmaceutical companies was calculated. Percentage variation was calculated as per the following formula Drug formulations manufactured by only one company and those whose price could not be obtained from the sources were excluded from analysis. Results: Maximum companies are manufacturing single drug atorvastatin 10mg (192) and atorvastatin 5 mg + ezetimibe 10mg (40). Highest percentage variation in cost is found with atorvastatin 5 mg (900%) and in atorvastatin 10mg + amlodipine 5 mg (1488%). Conclusion: There is wide variation in the cost of various statins available in India, which increases the economic burden on patients. Government of India should take more consumer friendly steps to control the cost of drugs. Physicians should maintain a P-drug list and prescribe low cost and effective drugs to improve compliance to drug therapy and ensure effective treatment of the disease. Keywords: Statins, Cost variation, Hyperlipidemias.

Survival benefit of statins in older patients with rectal cancer: A Swedish population-based cohort study.

Increasing evidence suggests that statins may have antitumor effects but their role in rectal cancer appears inconclusive. The aim of this study was to investigate whether statins may have an impact on survival of older and younger patients with rectal cancer. This study included 238 patients ≥70 years and 227 patients <70 years old, from the Southeast Health Care Region of Sweden, who were diagnosed with rectal adenocarcinoma between 2004 and 2013. In the older group (n = 238), statin use at the time of diagnosis was related to better cancer-specific survival (CSS) and overall survival (OS), compared to non-use (CSS: Hazard Ratio (HR), 0.37; 95% CI, 0.19-0.72; P = .003; OS: HR, 0.62; 95% CI, 0.39-0.96; P = .032). In the older group with stages I-III disease (n = 199), statin use was associated with better disease-free survival (DFS) compared to non use (HR, 0.18; 95% CI, 0.06-0.59; P = .005). The improvement of CSS, OS and DFS remained significant after adjusting for potential confounders. In the older group with stage III disease, statin users had better CSS and DFS compared to non-users (log rank P = .043; log-rank P = .028, respectively). In the older group with short course radiotherapy, statin use was related to better CSS (log-rank P = .032). No such association was present in the younger group. Statin use was related to improved survival in older patients with rectal cancer. This observation is important given the low cost and safety of statins as a drug.

Trends in Management of Dyslipidaemia in Australia Over the Last 5 Years

Objectives: Dyslipidaemia is one of the most prevalent chronic conditions in Australia. While statins have long been the first line treatment for dyslipidaemia, several new medications have been introduced in recent years. We examined the trends in prescription of lipid lowering medications in Australia over the past 5 years. Methods: Data was extracted from the Pharmaceutical Benefits Scheme (PBS). We assessed total number of scripts and costs of statins including Atorvastatin, Fluvastatin, Pravastatin, Rosuvastatin and Simvastatin, as well as Ezetimibe, Fenofibrate, Gemfibrozil, Colestyramine and Evolocumab from December 2013- December 2018. Linear trend modelling was used to analyse trends. Results: Statins continue to be the most commonly prescribed lipid lowering therapy, with Atorvastatin remaining the most popular across all states in Australia (44.1%). Rosuvastatin use increased by 265% from April to December 2018 (40.9%), surpassing Simvastatin (11.6%) as the 2nd most commonly prescribed statin. Of all non-statin drugs, Ezetimibe was the most popular followed closely by fibrates. Since their introduction in December 2016, uptake of Evolocumab has been steady and linear but slow. In December 2018, Evolocumab represented only 0.04% of all scripts but 2.58% of total cost of lipid lowering medications. Queensland had the highest uptake of Evolocumab followed closely by Victoria and New South Wales. Conclusions: Statins continue to be the mainstay treatment for dyslipidaemia in cardiovascular disease with recent increase in use of Rosuvastatin. Despite significant benefits of Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, uptake of Evolocumab appears slow in Australia.

Statin cost effective for CVD prevention in T2DM in China

Statin cost effective for CVD prevention in T2DM in China

Estimated Impact of US Preventive Services Task Force Recommendations on Use and Cost of Statins for Cardiovascular Disease Prevention.

US Preventive Services Task Force (USPSTF) released new recommendations on statin use for atherosclerotic cardiovascular disease (ASCVD) prevention. The Affordable Care Act (ACA) mandates USPSTF recommendations with an "A" or "B" grade receive insurance coverage without copayment. We assessed the potential impact of these recommendations. To assess the US population meeting criteria for statin use and factors associated with use, and calculate associated costs. We estimated 10-year ASCVD event risk scores from National Health and Nutrition Examination Survey data using Pooled Cohort Equations from the American College of Cardiology/American Heart Association and applied them to Medical Expenditure Panel Survey data. We estimated the population meeting USPSTF criteria and calculated the number of statin prescription fills and out-of-pocket and total costs. We assessed associations between statin use and sociodemographic and health characteristics and national trends in use from 1996 to 2014. A nationally representative sample of people aged ≥ 40years, representing 150 million people living in the USA. Of 26.8 million adults recommended for statins, only 41.8% were taking them. Female sex, Hispanic ethnicity, uninsured status, or living in the South was associated with lower odds of using statins. Under ACA, people with private insurance would avoid out-of-pocket cost of $9 for each generic prescription, resulting in savings of approximately $44 in annual costs. ACA's mandate for insurance coverage would result in a $193 million shift in out-of-pocket cost for statins from patients to private insurers. New USPSTF recommendations may result in decreased out-of-pocket costs and expanded access to statins. Previous research has shown that eliminating copayments increased adherence and decreased rates of ASCVD events without increasing overall healthcare costs. Future research will determine whether the USPSTF's recommendations will result in similar findings.

Cardiovascular Genetic Risk Testing for Targeting Statin Therapy in the Primary Prevention of Atherosclerotic Cardiovascular Disease: A Cost-Effectiveness Analysis.

It is unclear whether testing for novel risk factors, such as a cardiovascular genetic risk score (cGRS), improves clinical decision making or health outcomes when used for targeting statin initiation in the primary prevention of atherosclerotic cardiovascular disease (ASCVD). Our objective was to estimate the cost-effectiveness of cGRS testing to inform clinical decision making about statin initiation in individuals with low-to-intermediate (2.5%-7.5%) 10-year predicted risk of ASCVD. We evaluated the cost-effectiveness of testing for a 27-single-nucleotide polymorphism cGRS comparing 4 test/treat strategies: treat all, treat none, test/treat if cGRS is high, and test/treat if cGRS is intermediate or high. We tested a set of clinical scenarios of men and women, aged 45 to 65 years, with 10-year ASCVD risks between 2.5% and 7.5%. Our primary outcome measure was cost per quality-adjusted life-year gained. Under base case assumptions for statin disutility and cost, the preferred strategy is to treat all patients with ASCVD risk >2.5% without cGRS testing. For certain clinical scenarios, such as a 57-year-old man with a 10-year ASCVD risk of 7.5%, cGRS testing can be cost-effective under a limited set of assumptions; for example, when statins cost $15 per month and statin disutility is 0.013 (ie, willing to trade 3 months of life in perfect health to avoid 20 years of statin therapy), the preferred strategy (using a willingness-to-pay threshold of $50 000 per quality-adjusted life-year gained) is to test and treat if cGRS is intermediate or high. Overall, the results were not sensitive to assumptions about statin efficacy and harms. Testing for a 27-single-nucleotide polymorphism cGRS is generally not a cost-effective approach for targeting statin therapy in the primary prevention of ASCVD for low- to intermediate-risk patients.

EPA plus statin cost effective for secondary prevention of CVD

EPA plus statin cost effective for secondary prevention of CVD

Availability and Affordability of Essential Medicines and Diagnostic Tests for Diabetes Mellitus and Cardiovascular Diseases in Sub-Saharan Africa: A Systematic Review

Background: Diabetes mellitus (DM) and cardiovascular diseases (CVD) pose a significant health challenge in sub-Saharan Africa (SSA). Interventions to improve access to affordable essential medicines and diagnostic tests are needed to reduce morbidity and mortality due to these conditions. We performed this systematic review to evaluate the availability and affordability of essential medicines and diagnostic tests for DM and CVD in SSA, where health resources are particularly scarce. Methods: PubMed, Scopus and African Journal Online databases were searched for original research articles conducted in SSA between 2000 and March 2018 with information about availability and affordability of essential medicines and diagnostic tests for DM and CVD. Findings: Twenty cross sectional studies were identified with the majority performed in East African countries (n=12, 60%). Availability of insulin and oral hypoglycaemic agents (OHA) widely ranged from 0-100%. Angiotensin converting enzyme inhibitors, anti-platelet drugs and statins were available in 0-96.5%, 20.8-100% and 3.1-84% of surveyed health facilities respectively. Availability of blood glucose testing, glycated haemoglobin (HbA1c), electrocardiography (ECG) and troponin testing ranged from 6-100%, 20-43.5%, 9.1-81.8% and 0-43.2% respectively. The monthly cost of the majority of the lowest priced generic medicines and diagnostic tests was <3.5 days' wages. The cost of insulin, statins and unfractionated heparin widely ranged from 3.85-18.7 days' wages, 6.5-30.51 days' wages and 38.5-182.36 days' wages respectively. Interpretation: The availability and affordability of essential medicines and diagnostic tests for DM and CVD in SSA is suboptimal. Pragmatic solutions are urgently needed to address this challenge. Funding Statement: The authors declare: No funding was received for this work. Declaration of Interests: The authors declare no competing interests.

The impact of a physician detailing and sampling program for generic atorvastatin: an interrupted time series analysis

BackgroundIn 2011, Manitoba implemented a province-wide program of physician detailing and free sampling for generic atorvastatin to increase use of this generic statin. We examined the impact of this unique combined program of detailing and sampling for generic atorvastatin on the use and cost of statin medicines, market share of generic atorvastatin, the choice of starting statin for new users, and switching from a branded statin to generic atorvastatin.MethodsWe conducted a retrospective study of Manitoba insurance claims data for all continuously enrolled patients who filled one or more prescriptions for a statin between 2008 and 2013. Data were linked to physician-level data on the number of detailing visits and sample provision. We used interrupted time series analyses to assess policy-related changes in the use and cost of statin medicines, market share of generic atorvastatin, the choice of starting statin for new users, and switching from a branded statin to generic atorvastatin.ResultsThe detailing program reached 31% (651/2103) of physicians who prescribed a statin during the study period. Collectively, these physicians prescribed 61% of statins dispensed in the province. Free sample cards were provided to 61% (394/651) of the detailed physicians. The program did not change the level or trend in the overall statin use rate and the total cost of statins or increase the number of patients switching from another branded statin to generic atorvastatin. We found the program had a small impact on atorvastatin’s market share of new prescriptions, with a level increase of 2.6%.ConclusionsThough physician detailers were skilled at targeting high-prescribing physicians, a combined program of detailing visits and sample provision for generic atorvastatin did not lower overall statin costs or lead to switching from branded statins to the generic. The preceding introduction of generic atorvastatin appeared sufficient to modify prescribing patterns and decrease costs.

Statin Cost Effectiveness: A Systematic Review Including The Recent Literature

Statin Cost Effectiveness: A Systematic Review Including The Recent Literature

Assessing potential population impact of statin treatment for primary prevention of atherosclerotic cardiovascular diseases in the USA: population-based modelling study

ObjectiveNew cholesterol treatment guidelines from American College of Cardiology/American Heart Association recommend statin treatment for more of US population to prevent atherosclerotic cardiovascular disease (ASCVD). It is important to assess...

Access to Evidence-Based Statins in Low-Cost Generic Drug Programs.

In light of ongoing economic concerns and high costs of prescription medications, patients continue to be at risk of becoming noncompliant with their medication regimens because of cost constraints.1 The launch of low-cost generic drug programs (sometimes called $4 generic drug formularies) by major chain drugstore corporations would be expected to increase availability of prescription drugs to patients by reducing prescription costs.2 Compared with typically high prescription copays, low-cost generic drug plans make many medications more affordable and accessible to patients.3 It is uncertain whether low-cost generic drug programs also provide access to medications that promote evidence-based prescribing. Our study aimed to evaluate whether evidence-based statins are provided within the most common low-cost generic drug formularies. We chose statins because of their extensive evidence base for improving clinical outcomes, their prevalent use as top-selling medications in the United States, and the potential impact of low-cost generic drug formulary statin choices on a large patient population. To conduct this study, we selected low-cost generic programs provided by regional or national chain pharmacy corporations in the United States based on prescription sales volumes listed at National Pharmacy Market Summary, Chain Drug Review, and Drugstorenews.com. We excluded franchise pharmacies of mother companies (eg, Medicine Shoppe pharmacies), which are each independently owned and operated, and pharmacies with limited free-medication programs (eg, Publix pharmacies). The most current formulary coverage information for all statins, including drug, dose, cost, and supply, was extracted from July 1, 2014 to July 31, 2014, then …