Statins are some of the most commonly taken drugs world-wide. The last 20 years has seen them skyrocket into popularity from only being given to those with astronomically high cholesterol, to being handed out almost freely. With this trend we have also seen the plummet of deaths due to heart disease and the Cochrane Library have found them to be effective and with no major adverse effects.

Now with all this good news about statins, why should we be on our guard. Well they mostly have very similar efficacy, and they are a hugely lucrative market for pharmaceutical companies as you would expect given the eligible criteria encompasses millions of people in the UK alone. This means that despite new statins being released, which one you are on doesn’t matter especially for your health, though their prices differ enormously. All these factors mean that statins are an important issue for any health system.

Data from Open Prescribing, price averaged over CCG prescription data

This graph shows the average price per pill between the generic Simvastatin, and the branded Zocor (courtesy of Merck). Zocor isn’t even a different chemical. It’s still just simvastatin on the inside, yet their price are orders of magnitude apart. Just in case you think there’s some kind of magic pixy dust in Zocor, trials have found no discernible difference in its effects versus a generic. Essentially for every £1 you spend on Zocor, you’ve just wasted approximately £0.95. This isn’t even an isolated case, looking back to the previous post we found that the generic Atorvastatin cost 93% less than the branded Lipitor.

Thankfully most systems are wise this by now. Looking at the prescription data for NHS GPs we can see that generic statin prescriptions vastly outweigh branded ones. However in countries without nationalised healthcare, and so without regulations and large buying power, such as the US, approximately 20% of prescriptions are for branded medications, compared to about 2% here in the UK.

Lets take a closer look into statin prescriptions across England.

Data from Open Prescribing, for the year 2014

This shows the top distribution of statin prescription in England in the top prescribing CCGs, along with a national average. You can inspect closer by selecting a chemical from the legend. For instance if you select Simvastatin you can see that our good friend Zocor only makes up a fraction of a percent of statin prescriptions.

The immediate conclusion that can be drawn is that Simvastatin is really, really popular, a triumph for generic medications everywhere. What’s also interesting is that proportions of each statin vary quite considerably across the CCGs and that there’s the sneaky branded version of simvastatin, Simvador, creeping in there.

The variance in chemical shows part of the free reign given to GPs and CCGs across the country. Interestingly this distribution flies in the face of the recommendations of NICE which decided that Atorvastatin should be the golden child, after concluding that it was more cost effective.

As to the sneaky Simvador, it falls in the category of ‘branded generic’ in that it is not manufactured by the initial inventors of simvastatin but by GlaxoSmithKline. I’ve reached out to a few of the popularisers of Simvador, but have yet to receive a response. The only mention of it I can find is a report from 2007 using it as an example for organisations to hit their prescribing targets.

Finally where would we be without naming and shaming. This map shows the total cost of branded statins in the year 2014.

Data from Open Prescribing, for the year 2014

While there are a few obvious hotspots, I think the overall message of this is positive, most of the UK spends trivial amounts on branded statins compared to their outgoings on generics.

To wrap things up, I don’t want to give the impression that it’s as simple as ‘Generic Good’ and ‘Branded Bad’. The comparisons here are only on a selection of almost equally performing drugs.