Growth in use of lipid-lowering therapies: are we targeting the right patients?

Prescription drug spending has been rising at > 10% per year, with volume of use (rather than price) being the primary driver for that growth. Concern exists that industry marketing has led to increased use of medications by patients with marginal indications.

To determine whether the increase in the number of patients receiving lipid-lowering therapy represents a shift away from treatment of patients at highest cardiovascular (CV) risk towards patients in lower risk categories.

Cardiovascular risk criteria adapted from guidelines were applied to an administrative database of medical and pharmaceutical claims for 1997 and 1999 that included managed care plan enrollees in 22 states. Patients were assigned to 1 of 7 categories representing CV risk based on documentation of CV disease/risk factors, with category 1 and 2 indicating the highest risk group (secondary prevention). The odds of the treated population being in the highest risk during 1997 versus 1999 were calculated, adjusting for age and sex.

Patients treated with lipid medications in the study population increased from 5% in 1997 to 8% in 1999. During the same period, the percentage of treated patients in categories 1 through 6 rose from 17% to 21%. The odds of the treated population being in the highest risk group did not differ significantly between the 2 years (odds ratio (OR) = 0.99; 95% confidence interval, (CI) 0.96-1.01; P = .40).

Despite an increase in the percentage of patients receiving lipid-lowering therapy from 1997 to 1999, treatment rates rose modestly across all categories. Greater overall use did not appear to be associated with a shift in use towards patients with less CV risk.