Variations and increase in use of statins across Europe: data from administrative databases
http://www.100md.com
《英国医生杂志》
1 Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool L69 3GF, 2 IRPPS/CNR, via Nizza 128, I-00198 Rome, Italy, 3 Pharmacologisckes Institut, Ruprecht-Karls-Universit?t Im Neuenheimer Feld 366, 69120-Heidelberg, Germany, 4 Unité de Pharmacoépidémiologie, University of Lyon, France
Correspondence to: T Walley twalley@liv.ac.uk
Introduction
Our analysis shows enormous variation in statin use across Europe and a rapid increase in use. Variations in morbidity may explain some of the differences in use (such as between Italy and Britain) but not all (as between Norway and Denmark). We must consider other explanations, and these may lie in factors unique to each country: for example, differences between Norway and Denmark may reflect the involvement of Norwegian doctors in seminal trials, while in Denmark these drugs were only reimbursed from 1998 onwards and their use has lagged behind other countries. Low use in Italy may reflect low coronary morbidity or poor adherence of Italian patients to statins, worse than elsewhere in Europe.4 Other differences may lie in national guidance and policies. These national figures also hide wide variations within countries.5
The rapid increase in use may be due to a growing awareness of the effectiveness of these drugs as their evidence base has expanded2 or to government policies that have stressed more aggressive management of risk factors for ischaemic heart disease (such as in Britain). Some of the effect may be due to successful marketing, particularly since the market leaders in many countries were drugs with no evidence of benefits in mortality at the time. This may also explain in part why the heaviest use was in France, which had relatively low cardiovascular mortality even before statins were available. Political, cultural, and social issues determine such use as well as medical indications. In view of the public health implications, these merit more specific study in each country.
Potential influences on results and supplementary data are on bmj.com
Contributors: All members of EuroMedStat contributed to data collection and analysis. All named authors helped to draft this article. PF-G is the project coordinator. TW is guarantor for the article.
Funding: This work was funded by the European Commission, which had no role in the design, data collection, data analysis, interpretation, or writing of this report.
Competing interests: EvG has received unrestricted research funds from a company that manufactures a statin.
References
World Health Organization. European health for all database. Updated January 2003 http://www.euro.who.int/hfadb (accessed 29 Apr 2003).
Sudlow C, Lonn E, Pignone M, Ness A, Rihal C. Secondary prevention of ischaemic cardiac events. In: Clinical evidence. Issue 9. London: BMJ Publishing, 2003: 166-205.
The Euro-Med-Stat Group. Euro-Med-Stat: monitoring expenditure and utilisation of medicinal products in the European Union countries. A public health approach. Eur J Public Health (in press).
Larsen J, Vaccheri A, Andersen M, Montanaro N, Bergman U. Lack of adherence to lipid-lowering drug treatment. A comparison of utilization patterns in defined populations in Funen, Denmark and Bologna, Italy. Br J Clin Pharmacol 2000;49: 463-71.
Majeed A, Moser K, Maxwell R. Age, sex and practice variations in the use of statins in general practice in England and Wales. J Public Health Med 2000;22: 275-9.(Tom Walley, professor of )
Correspondence to: T Walley twalley@liv.ac.uk
Introduction
Our analysis shows enormous variation in statin use across Europe and a rapid increase in use. Variations in morbidity may explain some of the differences in use (such as between Italy and Britain) but not all (as between Norway and Denmark). We must consider other explanations, and these may lie in factors unique to each country: for example, differences between Norway and Denmark may reflect the involvement of Norwegian doctors in seminal trials, while in Denmark these drugs were only reimbursed from 1998 onwards and their use has lagged behind other countries. Low use in Italy may reflect low coronary morbidity or poor adherence of Italian patients to statins, worse than elsewhere in Europe.4 Other differences may lie in national guidance and policies. These national figures also hide wide variations within countries.5
The rapid increase in use may be due to a growing awareness of the effectiveness of these drugs as their evidence base has expanded2 or to government policies that have stressed more aggressive management of risk factors for ischaemic heart disease (such as in Britain). Some of the effect may be due to successful marketing, particularly since the market leaders in many countries were drugs with no evidence of benefits in mortality at the time. This may also explain in part why the heaviest use was in France, which had relatively low cardiovascular mortality even before statins were available. Political, cultural, and social issues determine such use as well as medical indications. In view of the public health implications, these merit more specific study in each country.
Potential influences on results and supplementary data are on bmj.com
Contributors: All members of EuroMedStat contributed to data collection and analysis. All named authors helped to draft this article. PF-G is the project coordinator. TW is guarantor for the article.
Funding: This work was funded by the European Commission, which had no role in the design, data collection, data analysis, interpretation, or writing of this report.
Competing interests: EvG has received unrestricted research funds from a company that manufactures a statin.
References
World Health Organization. European health for all database. Updated January 2003 http://www.euro.who.int/hfadb (accessed 29 Apr 2003).
Sudlow C, Lonn E, Pignone M, Ness A, Rihal C. Secondary prevention of ischaemic cardiac events. In: Clinical evidence. Issue 9. London: BMJ Publishing, 2003: 166-205.
The Euro-Med-Stat Group. Euro-Med-Stat: monitoring expenditure and utilisation of medicinal products in the European Union countries. A public health approach. Eur J Public Health (in press).
Larsen J, Vaccheri A, Andersen M, Montanaro N, Bergman U. Lack of adherence to lipid-lowering drug treatment. A comparison of utilization patterns in defined populations in Funen, Denmark and Bologna, Italy. Br J Clin Pharmacol 2000;49: 463-71.
Majeed A, Moser K, Maxwell R. Age, sex and practice variations in the use of statins in general practice in England and Wales. J Public Health Med 2000;22: 275-9.(Tom Walley, professor of )