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Potential Statin Overuse in Older Patients: A Retrospective Cross-Sectional Study Using French Health Insurance Databases

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Abstract

Background

Although compelling evidence exists supporting statins (HMG-CoA reductase inhibitors) for secondary prevention in older patients with clinical atherosclerotic diseases, the same cannot be said for primary prevention.

Objectives

The objectives of this study were to estimate the frequency of potential statin overuse in older patients, the potential drug cost savings if corrected, and the associated factors.

Methods

A retrospective cross-sectional study was conducted in Alsace and Lorraine (France) from 1 January to 30 April 2017. All statin users aged 80 years or over living in the community (including nursing homes) and identified from the French health insurance database were analyzed. Potential statin overuse was defined according to the STOPP/START (Screening Tool of Older People’s Prescriptions/Screening Tool to Alert to Right Treatment) criteria.

Results

Among the 38,268 aged insured, 23,228 (60.7%) had potential statin overuse. Of those living in the community, 22,132 (60.0%) patients had potential statin overuse: 12,352 (55.8%) for primary and 9780 (44.2%) for secondary prevention. Among nursing home residents, 1096 (79.0%) had potential statin overuse: 394 (35.9%) for primary and 702 (64.1%) for secondary prevention. The potential drug cost savings associated with the adjustment of potential statin overuse were €924,100 for the study period. Living in nursing home [adjusted odds ratio (ORadjusted) 3.91, 95% confidence interval (CI) 2.82–5.41] and being a female (ORadjusted 2.84, 95% CI 2.54–3.17) were the main risk factors associated with potential statin overuse.

Conclusion

The frequency of potential statin overuse is very high among older people aged 80 years or over, highlighting the need to re-evaluate statin therapy and consider deprescribing, particularly for primary prevention and in nursing homes.

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Acknowledgements

We wish to thank Annie Jelinski and Pascale Willem from the Regional Direction of Medical Service for supporting the study and extracting the anonymized data. We also thank Prof. Dominique Stephan, Prof. Eric-Andre Sauleau, Dr. François Severac, and Dr. François Lefebvre from the University Hospital of Strasbourg as well as Dr. Ulviyya Alizada, Thibaut Fabacher, Dr. Sylvie Fontanel, and Gaël Bialkowski from the Regional Health Agency for supporting the design. We also wish to thank Zahra Ashraf-Vonna and Valérie Leray-Michel for linguistic review, and finally Tess Bellanger and Michel Schmitt for declaration to the National Commission of Informatics and Liberty.

Author information

Authors and Affiliations

  1. OMEDIT Grand Est, Regional Health Agency, Strasbourg, France

    Emilie Borne, Marie-Christine Rybarczyck-Vigouret & Bruno Michel

  2. Department of Public Health, University Hospitals of Strasbourg, Strasbourg, France

    Nicolas Meyer

  3. Faculty of Medicine, University of Strasbourg, Strasbourg, France

    Nicolas Meyer & Thomas Vogel

  4. Regional Direction of Medical Service, Strasbourg, France

    Odile Blanchard & Martial Lombard

  5. Medical Centre, Montchoisi Clinic, Lausanne, Switzerland

    Pierre-Olivier Lang

  6. Department of Geriatrics, University Hospitals of Strasbourg, Strasbourg, France

    Thomas Vogel

  7. Service de Pharmacie, Hôpitaux Universitaires de Strasbourg, 1, place de l’Hôpital, 67091, Strasbourg Cedex, France

    Bruno Michel

  8. Faculty of Pharmacy, EA7296 Laboratory of Neuro-cardiovascular Pharmacology and Toxicology, University of Strasbourg, Strasbourg, France

    Bruno Michel

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  1. Emilie Borne
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Corresponding author

Correspondence to Bruno Michel.

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Funding

No external funding was used for the conduct of this study.

Conflict of interest

Emilie Borne, Nicolas Meyer, Marie-Christine Rybarczyck-Vigouret, Odile Blanchard, Martial Lombard, Pierre-Olivier Lang, Thomas Vogel, and Bruno Michel declare that they have no potential conflicts of interest that might be relevant to the contents of this study.

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Borne, E., Meyer, N., Rybarczyck-Vigouret, MC. et al. Potential Statin Overuse in Older Patients: A Retrospective Cross-Sectional Study Using French Health Insurance Databases. Drugs Aging 36, 947–955 (2019). https://doi.org/10.1007/s40266-019-00695-4

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  • DOI: https://doi.org/10.1007/s40266-019-00695-4

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