# Economic implications of the different statin prescribing patterns in Central Portugal: a longitudinal analysis

## TL;DR

This study examines how different statin prescription patterns in Central Portugal affect healthcare costs and patient treatment rates over time.

## Contribution

The study provides new insights into regional statin prescribing patterns and their economic implications in Portugal.

## Key findings

- Statin consumption increased significantly, while cost per DDD and per inhabitant decreased over the study period.
- Municipalities showed discrepancies in statin prescription patterns, linked to the use of pitavastatin and monotherapy.
- Prescription of statins correlated with antidepressant prescriptions, suggesting potential prescribing behavior patterns.

## Abstract

Statins are one of the most widely used therapeutic classes and have significantly contributed to health care expenditures with reported variability between countries and regions. We aim to identify the economic implications of different statin prescription patterns in the central region of Portugal.

A retrospective longitudinal study of statin consumption between 2010 and 2022 in the central region, with data obtained from the national administrative claim database. Prescription and expenditure (retail price) were analysed at the municipality level. A score was created for the quartile position (1 = first to 4 = fourth) of each municipality in the distributions of consumption and expenditure for each year. An overall score was created for the study period by aggregating yearly scores. A four-quadrant analysis with the overall scores of cost/DDD and DDD/1000inhabitants/day (DID) was conducted. Bivariate and multivariate analyses were performed.

Statin consumption increased from 64 DDD/1000inhabitants/day (DID) to 149 DID, while cost/DDD and cost/inhabitant decreased from 0.77 € to 0.26 € and from 17.84 € to 13.99 €, respectively. Prescription pattern of high-intensity statins increased from 26% to 74% of the DDD consumed. A four-quadrant plot revealed discrepancies between the municipalities. These discrepancies were associated with the percentage of pitavastatin in DDD (F = 4.604; p = 0.005), and the percentage of statins monotherapy in DDD (F = 5.201; p = 0.003). Generalising the characteristics of high-level consumption and expenditure municipalities to the entire region would result in a 39.7% increase in expenditure but a 20.8% increase in patients. Prescription of statins per municipality correlated with the prescription of antidepressants (R = 0.643; p < 0.001) in the bivariate analysis, and in the multivariate analysis (p < 0.001; B = 0.580; 95%CI = 0.416:0.744).

Differences in prescribing patterns resulted in very different proportions of patients treated and expenses associated with the consumption of these lipid-lowering agents. Further analysis should be carried out to understand the financial implications of prescribing new (patent-protected) medicines in Portugal.