Use of Niacin in the United States and Canada

Study Questions:

Has extended-release niacin use changed over time, and do patterns of usage differ between the United States and Canada?

Methods:

This was a population-level, observational cohort study using prescription data from 2002 to 2009. Patterns of niacin use were examined using IMS Health National Prescription Audit for the United States and IMS Brogan CompuScript Audit for Canada. Both use pharmacy audits to measure the number of dispensed prescriptions and expenditures. Rates of dispensed niacin and statin prescriptions were calculated overall and by product and by country. Canadian costs were converted to US costs using yearly purchasing power parity values.

Results:

Between 2002 and 2009, niacin use increased by 191.2% relative to baseline, to reach 696,000 prescriptions per month in the United States in December 2009, while statin use increased 71.9% to reach 16,781,000 prescriptions per month (p < 0.001). In Canada, from 2005 to 2009 (when Niaspan [Abbott Laboratories] was introduced), niacin use increased sevenfold relative to baseline to reach 13,876 prescriptions per month, while statin use increased 164.1% (p < 0.001). Of all US niacin prescriptions in 2009, 81.6% were for Niaspan, and Advicor (niacin plus lovastatin; Abbvie Inc.) and Simcor (niacin plus simvastatin; Abbvie Inc.) represented 18.4% of the US niacin market. In Canada, in 2009, 85.5% of niacin prescriptions were for Niaspan, but only 1.7% were for Advicor (Simcor was unavailable). Niacin prescriptions increased in both countries over the 8-year period, but the rate of increase in niacin use was higher in Canada (p < 0.001). The rate of increase relative to baseline use in each country was higher in the United States compared with Canada (p < 0.001), and in 2009, niacin prescriptions per 100,000 population were approximately sixfold higher in the United States (p < 0.001). In 2009, prescription niacin expenditures in the United States totaled $881,239,000, of which $732,194,000 were for Niaspan, while in Canada, the expenditures were only $12,927,523 and $12,377,867. Niacin expenditures per 100,000 population in 2009 were nearly sevenfold higher in the United States compared with Canada.

Conclusions:

The authors concluded that prescription niacin sales are substantial and growing, even in the absence of contemporary supportive trial evidence. The discordance between sales and evidence should be a focus of professional dialogue about the role of this medication in the medical armamentarium.

Perspective:

An examination of prescribing patterns in relation to results of large studies often suggest health care providers’ management practices lag behind current evidence. This supports the need for quick timely updates in practice guidelines to assist providers in synthesizing recent findings into clinical practice.

Clinical Topics: Dyslipidemia, Nonstatins, Novel Agents, Statins

Keywords: Drug Combinations, Lovastatin, Cardiology, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Canada, Hypolipidemic Agents, Cardiovascular Diseases, Health Expenditures, Costs and Cost Analysis, Niacin, Simvastatin, United States


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