Centre for Healthy Aging, Department of Public Health, University of Copenhagen, Denmark.
Health Policy. 2012 Dec;108(2-3):216-27. doi: 10.1016/j.healthpol.2012.08.008. Epub 2012 Sep 10.
Introduced to reduce mortality after myocardial infarction (MI), statins are now recommended for a range of other conditions, including asymptomatic individuals without cardiovascular disease or diabetes. The aim was to describe trends in Danish statin utilization according to indication and age during 1996-2009, and to analyse changing prescribing and purchasing behaviour during time intervals (driver periods) a priori defined by potential influential factors.
A nationwide cohort (N=4,998,580) was followed in Danish individual-level registries. Based on a hierarchy of register markers of indications for statin prescribing, we analysed incidence and prevalence of use by age and indication (age ≥ 40). Applying Poisson regression, we calculated Incidence Rate Ratios (IRR) of statin treatment for the last year of each driver period, applying the first year as reference.
Treatment prevalence increased from 7/1000 to 187/1000, representing a shift towards lower-level indications and increased relatively more in individuals aged 75+. While treatment prevalence in MI-patients reached 780/1000, asymptomatic individuals represented 50% of incident statin-users in 2009. A marked increase in incidence of statin use occurred during 1999-2003 (IRR=3.05) across all indications, followed by a more moderate rise during 2003-2006 (IRR=1.29) and 2006-2008 (IRR=1.15) - most marked increases in asymptomatic individuals. A sudden decrease was observed in 2009 (IRR=0.82) for all indications and ages.
While patent expiry and lower prices most likely boosted the general increase in statin utilization, the gradually altered indication and age pattern seems to be driven by guidelines, influencing both reimbursement rules and general healthcare policies. A media debate on statin side effects may have modified the general attitudes.
他汀类药物最初被引入是为了降低心肌梗死（MI）后的死亡率，现在推荐用于多种其他情况，包括无心血管疾病或糖尿病的无症状个体。目的是描述 1996-2009 年期间丹麦他汀类药物的使用趋势，根据适应症和年龄进行描述，并分析在预先定义的时间段（驱动期）内处方和购买行为的变化，这些时间段受潜在影响因素的影响。
对丹麦个体登记册中的一个全国性队列（N=4,998,580）进行了随访。基于他汀类药物处方适应症的登记标记分层，我们按年龄和适应症（年龄≥40 岁）分析了使用率的发生率和流行率。应用泊松回归，我们计算了每个驱动期最后一年的他汀类药物治疗的发病率比值（IRR），第一年作为参考。
治疗的流行率从 7/1000 增加到 187/1000，表明向低级别适应症转变，并在 75 岁以上人群中相对增加更多。虽然 MI 患者的治疗流行率达到 780/1000，但在 2009 年，无症状个体占新开始使用他汀类药物患者的 50%。所有适应症的他汀类药物使用率在 1999-2003 年期间显著增加（IRR=3.05），随后在 2003-2006 年（IRR=1.29）和 2006-2008 年（IRR=1.15）期间略有增加 - 在无症状个体中增加最显著。在 2009 年，所有适应症和年龄的使用率都突然下降（IRR=0.82）。
虽然专利过期和较低的价格很可能推动了他汀类药物使用的普遍增加，但适应症和年龄模式的逐渐改变似乎是由指南驱动的，这既影响了报销规则，也影响了一般医疗保健政策。关于他汀类药物副作用的媒体辩论可能改变了人们的普遍态度。
