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STATISTICAL BRIEF #154:
The Top Five Therapeutic Classes of Outpatient Prescription Drugs Ranked by Total Expense for Adults Age 18 and Older in the U.S. Civilian Noninstitutionalized Population, 2004

December 2006

Marie N. Stagnitti, MPA

Highlights

In 2004, for adults the top five therapeutic classes when ranked by total expense for prescription drugs were cardiovascular agents ($31.7 billion), hormones ($24.5 billion), central nervous system agents ($23.7 billion), antihyperlipidemic agents (21.5 billion), and psychotherapeutic agents ($17.9 billion).
Expenditures on the top five therapeutic classes when ranked by total expense totaled $119.3 billion and represented two thirds (65.9 percent) of total expenditures spent on prescription drugs by the adult population ($181.0 billion) in 2004.
During 2004, cardiovascular agent prescription medicine expenses accounted for 17.5 percent of total prescription drug expenses by adults.
Over 40 percent (44.2 percent) of the adult population with a prescribed drug expense in 2004 purchased a central nervous system agent, and exceeded the percentage of adults purchasing a drug in each of the remaining top four therapeutic classes.
In 2004, of the top five therapeutic classes for adults, antihyperlipidemic agents had the highest average expense per prescription ($100.44), and was more than double the average expense of the therapeutic class with the lowest average expense, cardiovascular agents ($47.55).

Introduction

This Statistical Brief provides a summary of the top five therapeutic classes of outpatient prescription drugs for adults age 18 and older when ranked by total expense, as reported by households in the U.S. civilian noninstitutionalized population in calendar year 2004. The brief also provides estimates for the population age 18 and older on the percentage of annual prescribed drug expenses the top five therapeutic classes represented, the percentage of those with a prescribed drug expense having an expense in these classes of drugs, and the mean expense in these classes of drugs.

The estimates in this brief are derived from the Household Component of the 2004 Medical Expenditure Panel Survey (MEPS-HC). Only prescribed medicines purchases in an outpatient setting are included in the estimates. Insulin and diabetic supplies and equipment are included in MEPS prescribed medicines estimates. Over-the-counter medicines are excluded from these estimates as are prescription medicines administered in an inpatient setting or in a clinic or physician's office. All differences discussed in the text are statistically significant at the 0.05 level.

Findings

In 2004, the top five therapeutic classes for prescribed drugs purchased by adults age 18 and older when ranked by total expense totaled $119.3 billion and represented 65.9 percent of the $181.0 billion total prescription drug expenses by adults (estimates not shown). Cardiovascular agents ranked first in terms of total expenses at $31.7 billion and was higher than the total expenses spent on any of the remaining top four therapeutic classes (hormones ($24.5 billion), central nervous system agents ($23.7 billion), antihyperlipidemic agents ($21.5 billion), and psychotherapeutic agents (17.9 billion)). Total annual expenses for hormones and total expenses for central nervous system agents were higher than total expenses for psychotherapeutic agents. (figure 1)

In 2004, annual expenses for cardiovascular agents accounted for 17.5 percent of total prescription drug expenses by the adult population, and was a higher percentage than each of the remaining four therapeutic classes in the top five represented. The 9.9 percent that psychotherapeutic agents represented of total prescribed drugs purchased by adults in 2004 was lower than the percentage that hormones (13.5 percent), central nervous system agents (13.1 percent) and antihyperlipidemic agents (11.9 percent) represented. In addition, the 13.5 percent of total drug expenses by adults that hormones represented was higher than the percentage represented by antihyperlipidemic agents (11.9 percent). (figure 2)

In 2004, for adults with a prescribed drug expense, central nervous system agents had the highest percentage of adults purchasing at least one (44.2 percent) as compared to the other four categories in the top five therapeutic classes of prescription drugs when ranked by total expense. The percentage of adults purchasing a cardiovascular agent (37.5 percent) and the percentage of adults purchasing a hormone (36.9 percent) were higher than the percentage of adults purchasing antihyperlipidemic agents (22.0 percent) and psychotherapeutic agents (20.1 percent). (figure 3)

Of the top five therapeutic classes when ranked by total expense for adults in 2004, antihyperlipidemic agents had an average expense per prescription of approximately $100 ($100.44), which was higher than the average expense for the remaining four classes in the top five: cardiovascular agents ($47.55), hormones ($54.32), central nervous system agents ($61.58), and psychotherapeutic agents ($80.76). The average expense for psychotherapeutic agents ($80.76) was higher than the average expense for central nervous system agents ($61.58) and hormones ($54.32), and the average expense for central nervous system agents was higher than the average expense for hormones. In contrast, the average expense for cardiovascular agents, $47.55, was lower than the average expense for the other classes in the top five therapeutic classes. (figure 4)

Definitions/Methodology

Therapeutic classes were assigned to drugs using Multum Lexicon variables from Cerner Multum, Inc. Please note, the therapeutic class of central nervous system agents includes the large subclass of analgesics; the therapeutic class of antihyperlipidemic agents includes the large subclass of HMG-COA reductase inhibitors; and the therapeutic class of psychotherapeutic agents includes the large subclass of antidepressants. For additional information on these and other Multum Lexicon variables, as well as the Multum Lexicon database itself, refer to the following Web site: http://www.multum.com/Lexicon.htm.

About MEPS-HC

MEPS-HC is a nationally representative longitudinal survey that collects detailed information on health care utilization and expenditures, health insurance, and health status, as well as a wide variety of social, demographic, and economic characteristics for the civilian noninstitutionalized population. It is cosponsored by the Agency for Healthcare Research and Quality and the National Center for Health Statistics.

For more information about MEPS, call the MEPS information coordinator at AHRQ (301-427-1656) or visit the MEPS Web site at http://www.meps.ahrq.gov/.

References

For a detailed description of the MEPS survey design, sample design, and methods used to minimize sources of nonsampling error, see the following publications:

Cohen, J. Design and Methods of the Medical Expenditure Panel Survey Household Component. MEPS Methodology Report No. 1. AHCPR Pub. No. 97-0026. Rockville, Md.: Agency for Health Care Policy and Research, 1997.

Cohen, S. Sample Design of the 1996 Medical Expenditure Panel Survey Household Component. MEPS Methodology Report No. 2. AHCPR Pub. No. 97-0027. Rockville, Md.: Agency for Health Care Policy and Research, 1997.

Cohen, S. Design Strategies and Innovations in the Medical Expenditure Panel Survey. Medical Care, July 2003: 41(7) Supplement: III-5-III-12.

Suggested Citation

Stagnitti, M. N. The Top Five Therapeutic Classes of Outpatient Prescription Drugs Ranked by Total Expense for Adults Age 18 and Older in the U.S. Civilian Noninstitutionalized Population, 2004. Statistical Brief #154. December 2006. Agency for Healthcare Research and Quality, Rockville, MD. http://www.meps.ahrq.gov/mepsweb/data_files/publications/st154/stat154.shtml

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AHRQ welcomes questions and comments from readers of this publication who are interested in obtaining more information about access, cost, use, financing, and quality of health care in the United States. We also invite you to tell us how you are using this Statistical Brief and other MEPS data and tools and to share suggestions on how MEPS products might be enhanced to further meet your needs. Please e-mail us at mepspd@ahrq.gov or send a letter to the address below:

Steven B. Cohen, PhD, Director
Center for Financing, Access, and Cost Trends
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850

Table containing figure values follows image.

	Dollars in billions for 18 and older adult population
Figure 1. Top five therapeutic classifications for prescribed drugs ranked by total expense for adults, 2004
Cardiovascular agents	31.7
Hormones	24.5
Central nervous system agents	23.7
Antihyperlipidemic agents	21.5
Psychotherapeutic agents	17.9
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2004

	Percent of total expenses for 18 and older adult population
Figure 2. Percentage of total prescribed drug expenses by the adult population that the top five therapeutic classes ranked by annual expense represent, 2004
Cardiovascular agents	17.5
Hormones	13.5
Central nervous system agents	13.1
Antihyperlipidemic agents	11.9
Psychotherapeutic agents	9.9
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2004

	Percent of 18 and older adult population
Figure 3. Percentage of adults with a prescribed drug expense having an expense in the top five therapeutic classes ranked by total expense, 2004
Cardiovascular agents	37.5
Hormones	36.9
Central nervous system agents	44.2
Antihyperlipidemic agents	22.0
Psychotherapeutic agents	20.1
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2004

	Dollars per prescription for 18 and older adult population
Figure 4. Average expense per prescription for the top five therapeutic classes of prescribed drugs ranked by total expense for adults, 2004
Cardiovascular agents	47.55
Hormones	54.32
Central nervous system agents	61.58
Antihyperlipidemic agents	100.44
Psychotherapeutic agents	80.76
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2004

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STATISTICAL BRIEF #154: The Top Five Therapeutic Classes of Outpatient Prescription Drugs Ranked by Total Expense for Adults Age 18 and Older in the U.S. Civilian Noninstitutionalized Population, 2004