Statins cost four times more in US than UK

I wonder why?
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The cost of statins in the US is radically higher than the costs paid for the same brands in the UK, and many more insured Americans are prescribed statins, raising the overall costs in that country [1]. According to Dr Hershel Jick (Boston University School of Medicine, MA) and colleagues, who used 2005 numbers for their analysis, statin costs were as much as 400% higher in the US than in the UK. They report their findings in the January 2012 issue of Pharmacotherapy.

Speaking with heartwire, Jick pointed to an earlier study he did looking at prescribing patterns in the US and the UK, showing that drugs were prescribed in far greater numbers in the US [2]. This new paper provides a missing piece that wasn't available previously, Jick said, adding that the sheer difference in costs should shock others as much as it did him.

"I don't like to talk too much about my science, and I have to remain impartial," he said. "But this really blew me away."

Jick et al looked at US citizens aged 55 to 65 who were covered by private insurance plans who'd been prescribed at least one drug in 2005. UK subjects, whose data are housed in the public UK General Practice Research Database and whose drug costs were covered under the public plan, were matched by age and sex with 280 000 insured American patients.

Of these, write Jick et al, 33% of Americans were prescribed a statin as compared with 24% of the matched British subjects. The analysis included only patients who received continuous statin therapy over the course of the year.

Researchers then explored the type of statins being prescribed in both countries and the cost of those drugs, yielding some surprises. While the lowest-priced statin in the US at the time, generic lovastatin, cost $313 per year, the lowest-priced statin in the UK, generic simvastatin, cost just $164. At the high end, nongeneric simvastatin in the US cost $1428 per patient per year, while the top-priced statin in Britain was nongeneric atorvastatin, which cost $509 per patient per year.

Indeed, different statins were generic in the two countries in 2005: in the US, lovastatin was the only generic statin on the market, whereas in the UK in 2005 both simvastatin and pravastatin were generic and lovastatin was not sold. For brand-name drugs available in both countries, however, American costs were double the British costs for both atorvastatin ($997 vs $509) and rosuvastatin ($903 vs $467), while the cost of fluvastatin was nearly three times higher in the US than in the UK ($763 vs $258).

"I've done a lot of research of this variety, and I knew the cost would be higher in the US," Jick said. "But frankly, I was pretty stunned by the difference."

Given the greater proportion of patients taking statins and the higher costs, researchers estimate the total cost of statin use in the US in 2005 at $64.9 million compared with just $15.7 million in the UK. Jick et al's sample included just 1% of the US population in this age group who were taking a statin over the course of the year, so this represents just a fraction of the US spending on statins.

Finally, in an addendum to their paper, Jick et al note that generic simvastatin was approved in the US market in mid-2006, prompting them to do some recalculations. They noted that in the six months postapproval, more than 60% of US users switched from brand-name simvastatin to a generic formulation, leading to a 60% drop in US costs. Even still, the US price for generic simvastatin remained nearly four times higher than the cost of the generic formulation available in the UK.

Jick notes that private insurers cover roughly 200 million US citizens, but that the military, veterans, government employees, the elderly, and other groups have their drugs covered by the government, and there is no publicly available information as to just what the price is that the government pays companies for the same products. Estimates of drug costs in these groups "could provide a useful basis for further insight into the nature of the remarkable difference—at least for statins—in prescription drugs costs between the US and UK," the authors write.