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MANAGED CARE

How Many "Me-Too" Drugs Are Enough? The Case of Physician Preferences for Specific Statins

Senior Scientist, Institute for Clinical Evaluative Sciences, Toronto, Canada; Associate Professor, Departments of Public Health Sciences and Health Policy, Management and Evaluation, University of Toronto, Toronto

Muhammad M Mamdani, PharmD MA MPH

at time of writing, Senior Scientist, Institute for Clinical Evaluative Sciences; Associate Professor, Faculty of Pharmacy, and Department of Health Policy, Management and Evaluation, University of Toronto; now, Director, US Outcomes Research, Pfizer, Inc., New York, NY

David N Juurlink, MD PhD

Clinical Pharmacologist, Sunnybrook and Women's College Health Sciences Centre, Toronto; Staff Physician, Divisions of General Internal Medicine and Clinical Pharmacology and Toxicology, Sunnybrook and Women's College Health Sciences Centre, Toronto

Reprints: Dr. Austin, Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Ave., Toronto M4N 3M5, ON, Canada, fax 416/480-6048, peter.austin{at}ices.on.ca

BACKGROUND: The increasing availability of "Me-Too" drugs has provided considerable treatment options for clinicians. However, the number of such drugs within a class that are actually used by clinicians has not been well studied.

OBJECTIVE: To determine the number of different statins that individual physicians use in practice.

METHODS: The Ontario Drug Benefit database was used to identify physicians who issued at least 10 incident statin prescriptions between October 2001 and May 2003 for patients aged 66 years and older. A preferred statin was defined for each physician, and the proportion of each physician's incident prescriptions written for that agent was determined. We then determined the number of different statins required to fill each physician's incident prescribing needs.

RESULTS: A total of 3426 physicians wrote 73 571 incident statin prescriptions. The mean percentage of prescriptions written for each physician's preferred statin formulation was 73.7%. Repeat analysis to examine the proportion of prescriptions filled using each physician's top 2 statin formulations found that the average physician wrote the vast majority of his or her incident prescriptions (94.9%) for only 1 or 2 statins. Half of all physicians used, at most, 2 different statins for all incident prescribing, while 91.3% of physicians used, at most, 3 different statins for all of their incident prescribing.

CONCLUSIONS: A high proportion of Ontario physicians issued the majority of their incident statin prescriptions for the same statin formulation. Most physicians required, at most, 3 different statins for all incident statin prescribing.

Key Words: cholesterol, drug benefits formulary, health services research, lipids, prescribing practices

Published Online, May 16, 2006. www.theannals.com, DOI 10.1345/aph.1G654