Study: How behind-the-counter statin use would affect the U.S.
Offering patients access to behind-the-counter drugs may increase usage; however, a study evaluating how access to behind-the-counter simvastatin in the U.K. affected utilization and pricing found that statin usage increased but expenditures did not. The study was published online Aug. 30 in Health Services Research.

“Finding ways to improve access to pharmaceuticals has received much attention from policymakers and researchers, with significant effort being devoted toward examining how financial barriers such as insurance status and cost-sharing affect access, health and medical costs,” Neeraj Sood, PhD, University of Southern California, Los Angeles, and colleagues wrote. On top of these issues, patients also struggle with access to care.

Sood and colleagues used simvastatin data from the U.K. and four other countries between 1997 and 2007 to better understand how the introduction of behind-the-counter simvastatin (Zocor, Merck) affected pricing, expenditures and utilization in the U.K. In 2004, simvastatin was made available as a behind-the-counter purchase for patients with a moderate risk for coronary heart disease, for whom prescription-strength statins were not indicated.

During the study, Sood and colleagues compared outcomes before and after the introduction of behind-the-counter simvastatin (10 mg dose), using outcomes in countries where the drug remained prescription only to control for possible confounders. The researchers found that introducing behind-the-counter simvastatin reduced expenditures by an estimated 61 percent. Additionally, prices of simvastatin were reduced by 77 percent.

“These results suggest that the introduction of BTC [behind-the-counter] statins in the United States, especially the 10 mg strength, could increase overall statin utilization,” the authors wrote. “In the United States, these effects could be quite large.”

Statins accounted for nearly $19.7 billion in expenditures in 2005. Introducing behind-the-counter lower-strength statins could have the potential to reduce U.S. expenditures for this drug class. Additionally, the authors speculated that selling these drugs behind the counter could also lead to the reduction of expenditures on physician office visits.

In fact, Sood and colleagues estimated nearly 78 million office visits in which simvastatin was prescribed and 295 million office visits in which a prescription for any statin was written between 2000 and 2005. With an average price of $155 and a median price of $72 per office visit, making statins available behind the counter may save hundreds of millions of dollars annually.

“In sum, our analysis finds the introduction of BTC statins dramatically increased utilization and reduced expenditures in the United Kingdom. If these effects were to carry over to the United States, the potential for savings could be tremendous,” they wrote.

The authors concluded that future research must investigate the potential health effects of introducing behind-the-counter statins to the U.S. For example, if increases in utilization are inappropriate and used by patients without cardiovascular risk factors, patients’ health could be worse off, despite the fact that expenditures would decrease.