RESUMO
INTRODUCTION: Due to their morbidity and mortality, cardiovascular diseases are one of the most significant public health problems in industrialized countries, including Portugal. The appropriate use of lipid-lowering drugs to prevent and treat these diseases is therefore of major and increasing importance in therapy today, in terms of both public health and allocation of financial resources by the health system. OBJECTIVES: The present study aims to characterize use and expenditure for lipid-lowering drugs in Portugal, and the impact of current policies on their consumption and cost. METHODS: The analysis refers to lipid-lowering drugs prescribed and dispensed to outpatients in mainland Portugal covered by the National Health Service (NHS) between January 1, 1995 and June 30, 2004. The Anatomical Therapeutic Chemical classification index recommended by the World Health Organization was used in order to calculate various utilization and expenditure indicators. RESULTS: The use of lipid-lowering drugs in Portugal showed a large increase in terms of defined daily doses per 1000 inhabitants per day (DID), from 10.21 DID in 1995 to 67.93 DID in 2004, mainly due to increased use of statins (an average annual growth of 34.5%). Expenditure on lipid-lowering drugs reached around 123 million euros in 2003, representing. 5% of total NHS expenditure on outpatient medicines. However, the daily treatment cost of these medicines has decreased, particularly in the case of statins and more markedly following increased availability of generic medicines. CONCLUSIONS: The study indicates a change in the pattern of lipid-lowering drug utilization and a more rational use of these medicines with the introduction of statins. The increased use of statins follows changes in clinical guidelines for the treatment of dyslipidemia and suggests a favorable evolution in the number of individuals taking statins, although this has had a significant impact on pharmaceutical expenditure, representing a major expense for patients and the NHS. In conclusion, the measures studied for expenditure containment have been successful in the case of statins, with significant development of the generics market (31% market share in 2004), reduction of costs (35% between 1995 and 2004) and hence increased access of patients to such therapy.