Lipid-lowering therapy in Switzerland: time trends in utilization and cost, 2015-2023.

BACKGROUND: National utilization trends of lipid-lowering therapy (LLT) have been studied for a subgroup of patients insured in Switzerland between 2013 and 2019. In 2019, the European Society of Cardiology (ESC) released new guidelines on the management of dyslipidaemia providing novel cholesterol targets. Additionally, new lipid-lowering compounds and combination drugs have been introduced. We aimed to evaluate trends in utilization and costs of LLT in Switzerland from 2015 to 2023, given the new ESC guidelines and drugs introduced. METHODS: We did a nationwide analysis of the Swiss tariff pool, a collection of administrative claims data covering all outpatient services for which an invoice has been submitted to compulsory health insurance across the country. We extrapolated defined daily doses (DDD) utilized, standardized DDD per 1,000 inhabitants, and cost of LLT. RESULTS: The rate of LLT utilization increased from 95.7 (95% CI: 95.6; 95.8) DDD per 1,000 population in 2015 to 113.1 (95% CI: 113.0; 113.2) in 2023. The overall cost increased from 217.96 million Swiss francs (2023 Euro: 250.1 million) to 274.91 million Swiss francs (2023 Euro: 297.7 million), respectively. The use of statins shifted from single compound drugs towards combination drugs with ezetimibe. PCSK9 inhibitors were increasingly used. Although their utilization was low, they were the main driver of the increasing costs. Their revenue market share increased from 0.4% in 2016 to 22.1% in 2023. CONCLUSION: We showed increasing LLT utilization, primarily driven by new combinations of established drugs. PCSK9 inhibitors are still rarely utilized, however, they have substantially influenced the observed increase in cost.