Comparison of Prescription Drug Costs in the United States and the United Kingdom, Part 1: Statins

Hershel Jick, M.D.; Andrew Wilson, M.P.H.; Peter Wiggins, M.B.; Douglas P. Chamberlin, B.A.

Disclosures

Pharmacotherapy. 2012;32(1):1-6. 

In This Article

Abstract and Introduction

Abstract

Study Objective To compare the annual cost of statins in the United States and in the United Kingdom.
Design Matched-cohort cost analysis.
Data Sources U.K. General Practice Research Database (GPRD), and MarketScan Commercial Claims and Encounters Database, a large, U.S. self-insured medical claims database.
Study Population We initially identified 1.6 million people in the GPRD who were younger than 65 years of age in 2005. These people were then matched by year of birth and sex with 1.6 million people in the U.S. database. From this matched pool, we estimated that 280,000 people aged 55–64 years from each country in 2005 were prescribed at least one drug. Of these, 91,474 (33%) in the U.S. were prescribed a statin compared with 68,217 (24%) in the U.K. After excluding those who did not receive statins continuously or who switched statins during the year, there remained 61,470 in the U.S. and 45,788 in the U.K. who were prescribed a single statin preparation continuously during 2005 (annual statin users). We estimated and compared drug costs (presented in 2005 U.S. dollars) separately in the two countries.
Measurements and Main Results Estimated drug costs were determined by random sampling. Estimated annual costs/patient in the U.S. ranged from $313 for generic lovastatin to $1428 for nongeneric simvastatin. In the U.K., annual costs/patient ranged from $164 for generic simvastatin to $509 for nongeneric atorvastatin. The total annual cost of the continuous receipt of statins in the U.S. was $64.9 million compared with $15.7 million in the U.K. In June 2006, after our study results were analyzed, the U.S. Food and Drug Administration approved generic simvastatin. We thus derived cost estimates for simvastatin use during 2006 and found that more than 60% of simvastatin users switched to the generic product, which reduced the cost/pill by more than 50%.
Conclusion The cost paid for statins in the U.S. for people younger than 65 years, who were insured by private companies, was approximately 400% higher than comparable costs paid by the government in the U.K. Available generic statins were substantially less expensive than those that were still under patent in both countries.

Introduction

Expenditures for prescription drugs remain a large part of the ongoing debate on the costs of medical care in the United States and the United Kingdom. Because of the many complex interactive variables that contribute to these costs, well-defined estimates of the actual and relative usage and costs for the two countries have not until recently been reliably documented.[1]

In July 2011, we published the results of a comprehensive study that described the frequency of prescribing for a majority of drugs, by comparing U.S. physicians with U.K. physicians during 2004–2006.[1] The current study was designed to go beyond drug usage to provide reliable well-documented estimates of actual and relative costs for prescription drugs, with comparison between the two countries. The results, as before, are based on two carefully constructed electronic longitudinal medical databases that provide continuous recording of prescription drugs in the context of general medical care. As part of a larger planned series, we initially provide estimates of costs for people who were prescribed statins in the two countries in 2005.

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