Despite Affordability, Low Utilization of Lipid Lowering Drugs in Iran: Trend Analysis and Benchmarking 2005-2016

Dyslipidemia is responsible for great mortality and morbidity each year. Little data are available on the availability and affordability of Dyslipidemia medications in low and middle incomes countries. In a retrospective time-series study, we examined the utilization pattern and affordability of lipid-lowering medications in Iran as a lower middle-income country. We initially calculated the defined daily dose for 1000 inhabitants (DID) in different years and compared the results with OECD member countries in the same year. We also used 90% Drug Utilization method to rank and compare lipid lowering drugs with the WHO Essential Medicines List (EML). We measured the affordability by the minimum daily wage for onemonth course of treatment. The use of lipid-lowering medications increased from 6.31 to 45.98 DID between 2005 and 2016. The utilization share of the subgroup of statins was above 80% of total utilization. Compared to OECD countries, Iran utilized 40% of the average utilization in 2015. In 2015, Atorvastatin was on 90% of DU medications. At the beginning of the study, only Lovastatin and Nicotinic acid were affordable in 2005, but at the end of the study, all lipidlowering medications were affordable. The utilization of lipid-lowering medications, despite being affordable, was low. One of its possible reasons is the lack of proper management of patients with Dyslipidemia and low adherence of patients. Another possible cause is the high percentage of undiagnosed patients in the community. Therefore, comprehensive planning and policy-making should be taken to increase utilization and eliminate the related obstacles.