Use of Fibrates in the United States and Canada

Study Questions:

What are the trends in use of fibrates in the United States and Canada?

Methods:

This was a population-level, observational cohort study using IMS Health data from the United States and Canada between January 2002 and December 2009. Monthly number of prescriptions and expenditures for fibrate products in the United States and Canada were the primary variables for analysis. Data included the number and cost of prescription dispensed, but not information on patient or prescriber characteristics. Pharmacy outlet populations were stratified by region, type (independent, chain, etc.), and size. Medication use and expenditures were standardized using 2001 census estimates from both countries. Rates of fibrate prescriptions dispensed overall and for each individual fibrate were calculated by country. Rates of changes from January 2002 to December 2009 were compared for each country.

Results:

In the United States, fibrate prescriptions dispensed increased from 336 prescriptions/100,000 population in January 2002, to 730 prescriptions/100,000 population in December 2009, which was an increase of 117.1% (95% confidence interval [CI], 116.0%-117.9%), whereas in Canada, fibrate prescriptions increased from 402 prescriptions/100,000 population in January 2002, to 474 prescriptions/100,000 population in December 2009, an increase of 18.1% (95% CI, 17.9%-18.3%) (p < 0.001). Statin use increased 71.9% (95% CI, 71.9%-71.9%) in the United States and 164.1% (95% CI, 163.9%-164.4%) in Canada. In the United States, fenofibrate prescriptions dispensed increased from 150 prescriptions/100,000 population in January 2002, to 440 prescriptions/100,000 population in December 2009, an increase of 159.3% (95% CI, 157.7%-161.0%), comprising 47.9% of total fibrate prescriptions in 2002 and 65.2% in 2009. In Canada, fenofibrate prescriptions increased from 321 prescriptions/100,000 population in January 2002, to 429 prescriptions/100,000 population in December 2009. The annual ratio of generic to brand name fenofibrate use in the United States ranged from 0:1 to 0.09:1 between 2002 and 2008, whereas the ratio in Canada steadily increased from 0.51:1 to 1.89:1 between 2005 and 2008. In the United States, crude fenofibrate expenditures increased from $11,535/100,000 population/month in 2002, to $44,975/100,000 population/month in 2009, whereas the rates in Canada declined from $17,695/100,000 population/month in 2002 to $16,112/100,000 population/month in 2009. Fibrate expenditures per 100,000 population were threefold higher in 2009 in the United States compared with Canada.

Conclusions:

The investigators concluded that over the past decade, prescriptions for fibrates increased in the United States, whereas prescription rates remained stable in Canada.

Perspective:

These data provide an interesting comparison of prescribing rates for the United States and Canada. As the authors suggest, given the recent evidence from randomized clinical trials, it is interesting to see increased use of fibrates in the United States. Analyses such as these can help the medical system with efforts to align practice patterns with current evidence-based recommendations.

Clinical Topics: Dyslipidemia, Nonstatins

Keywords: Fenofibrate, Fibric Acids, Canada, Thiazolidinediones, United States


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