Twenty-Year Nationwide Trends in Statin Utilization and Expenditure in Denmark
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During 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.
Methods and Results
Setting and Statistical Analysis
This study utilized data from 1996 to 2015. All inhabitants of Denmark have free access to tax-paid healthcare. Statin sales in the primary healthcare sector comprise purchases of prescription drugs only. Over-the-counter sale of statin is not available in Denmark. Drugs prescribed by physicians at discharge from hospitals or at ambulatory visits are dispensed from community pharmacies and therefore part of the primary sector sales. We retrieved data on use of statins according to the Anatomical Therapeutic Chemical classification system from the publicly accessible MEDical STATistics (Medstat), as described previously.4,5 Medstat has provided aggregate statistics on drug usage from the Danish primary sector since 1996. Although the pharmacy sale data in Medstat is only provided in aggregated format, it is based on individual-level prescription fillings. …