Tens of millions of people in the United States have a lipid abnormality or dyslipidemia. Given the inherent risk of cardiovascular disease that dyslipidemias carry, multiple prescription therapies are available for modifying lipid levels. The 2002 National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III guidelines recommend the use of statins (i.e., HMG-CoA reductase inhibitors) as the primary first-line treatment for the majority of patients with dyslipidemia, on top of lifestyle modifications. The aim of treatment is to reach target lipid levels. If these targets cannot be achieved, or the patient has a particular lipid abnormality, other therapies such as bile acid sequestrants, fibrates, cholesterol absorption inhibitors, niacin derivatives, and omega-3-acid ethyl esters can be used. The American Heart Association and the American College of Cardiology released new guidelines for the treatment of blood cholesterol in November 2013 that support the essence of the 2002 guidelines but highlight that there is little strong evidence to support the targeting of specific lipid levels or the use of any treatment other than statins. Using national patient-level claims data, this report analyzes physician adherence to the treatment guidelines by exploring the use of key therapies in the newly diagnosed and recently treated dyslipidemia patient populations. Among the newly diagnosed patients, the report provides a quantitative analysis of treatment patterns and share by line of therapy, as well as progression between lines, duration of treatment on each line, and use of concomitant treatment. Among recently treated patients, the report quantifies a drug’s source of business compared with its competitors and details which drugs precede others through an analysis of add-versus-switch patterns. Additional analyses explore persistency and compliance by brand.
Questions Answered in This Report:
- Newly diagnosed patients: Approximately 20% of dyslipidemia patients begin treatment with a key therapy within a year of their initial diagnosis. What percentage of these patients progress to a second- or third-line drug within the first year? Which products capture the most patient share in the first, second, and third lines of treatment? How often is combination therapy used in each line of therapy?
- Recently treated patients: Consistent with historical treatment patterns, the statin drug class continues to capture the majority of recently treated patient prescriptions. Which specific drugs garner the most patient share for recently treated dyslipidemia patients? When do patients progress from one therapy to the next in dyslipidemia, and how does this pattern differ between key drugs? Are most recently treated patients with each key brand coming through new (adds/switches) or continuing business?
- Pathways to key therapies: Longitudinal claims data reveal a modest increase in statin use among recently treated patients; use of nonstatin therapies for dyslipidemia increases in the later lines of therapy. Which therapies have experienced market growth or decline over the key therapy periods studied? To what extent are key therapies prescribed concomitantly to recently treated patients? What has been the impact of recently approved drugs for dyslipidemia?
Primary patient-level data: Quantitative findings from our analysis of data covering approximately 40 million lives providing the most representative sample of U.S. treatment practice for Medicare and commercially insured patients. This report is delivered as a key findings slide deck and a dashboard that can be accessed using the Internet with claims that are less than six months old at the time of publication.
Patients who are continuously enrolled for the complete two-year study period must meet the following condition: at least one claim with a diagnosis code for dyslipidemia (International Classification of Diseases, Ninth Revision [ICD-9] diagnostic codes [Disorders Of Lipoid Metabolism]: 272, 272.0, 272.1, 272.2, 272.3, 272.4, 272.5, 272.6, 272.7, 272.8, 272.9) during the study period. All patients must be aged 18 years or older to qualify.
Quantified lines of therapy analysis showing exact share of each agent in each line of therapy, including rate of progression between lines and length of time patients are on each line.
Newly Diagnosed Patients:
- Patient share by key products across three lines of therapy, within one year of diagnosis.
- Patient flowcharts through one year of treatment for all first-line products, including progression rates and add/switch behavior.
- Polypharmacy and key concomitant therapies by line of therapy.
- Quarterly trending of patient share by line of therapy.
Recently Treated Patients:
- Quarterly snapshot of patient share by key products.
- Pathway to key therapy flowcharts tracking the preceding therapy patterns for all key therapies, including add/switch behavior.
- Brand source of business including share for continuing, new (switches/adds), and new (initial therapy) business.
- Polypharmacy and key concomitant therapies.
- Drug persistence and compliance.
- Quarterly trending of patient share for all key therapies.