Despite Increased Use And Sales Of Statins In India, Per Capita Prescription Rates Remain Far Below High-Income Countries
- Niteesh K. Choudhry ( [email protected] ) is an associate professor at Harvard Medical School and an associate physician in the Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, in Boston, Massachusetts.
- Sagar Dugani is a resident in medicine at Brigham and Women’s Hospital.
- William H. Shrank was an associate physician in the Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital. when the work reported here was done. He is now chief scientific officer for CVS Caremark, in Woonsocket, Rhode Island.
- Jennifer M. Polinski is an assistant professor of medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital.
- Christina E. Stark was a research assistant at Brigham and Women’s Hospital when the work reported here was done. She is now a student nurse practitioner at the Yale School of Nursing, in Orange, Connecticut.
- Rajeev Gupta is director of research at Fortis Escorts Hospital, in Jaipur, India.
- Dorairaj Prabhakaran is a physician at the Center for Chronic Disease Control and the Center of Excellence–Center for Cardio-metabolic Risk Reduction in South Asia, at the Public Health Foundation of India, in New Delhi.
- Gregory Brill is a statistical programmer in the Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital.
- Prabhat Jha is director of the Centre for Global Health Research, in Toronto, Ontario.
Abstract
Statin use has increased substantially in North America and Europe, with resultant reductions in cardiovascular mortality. However, little is known about statin use in lower-income countries. India is of interest because of its burden of cardiovascular disease, the unique nature of its prescription drug market, and the growing globalization of drug sales. We conducted an observational study using IMS Health data for the period February 2006–January 2010. During the period, monthly statin prescriptions increased from 45.8 to 84.1 per 1,000 patients with coronary heart disease—an increase of 0.80 prescriptions per month. The proportion of the Indian population receiving a defined daily statin dose increased from 3.35 percent to 7.78 percent. Nevertheless, only a fraction of those eligible for a statin appeared to receive the therapy, even though there were 259 distinct statin products available to Indian consumers in January 2010. Low rates of statin use in India may reflect problems with access to health care, affordability, underdiagnosis, and cultural beliefs. Because of the growing burden of cardiovascular disease in lower-income countries such as India, there is an urgent need to increase statin use and ensure access to safe products whose use is based on evidence. Policies are needed to expand insurance, increase medications’ affordability, educate physicians and patients, and improve regulatory oversight.
