U.S. outpatient prescriptions for hydroxychloroquine and ivermectin increased 2- to 10-fold above pre-pandemic rates, respectively, to treat COVID-19, despite strong evidence disproving their effectiveness, new UCLA-led research shows.
Nearly three million COVID-related prescriptions were issued in the three and a half years between January 30, 2020 and June 30, 2023, totaling $272 million in estimated spending. Usage was three times higher among adults aged 65 and older compared with those aged 18 to 64. Ivermectin use in particular was higher among people living in the most socially vulnerable neighborhoods and markedly higher in the Southern United States.
These findings, published in the peer-reviewed journal Health Affairs, may inform future policies aimed at reducing the harms caused by reliance on non-evidence-based treatments, especially among vulnerable communities.
"Our findings underscore the urgent need for policy reforms to combat misinformation and mistrust in scientific institutions. Eliminating undue industry influence in government, enhancing transparency around scientific uncertainty, and earmarking public funding for clinical trials of new drugs are good places to start," said Dr. John Mafi , associate professor-in-residence in the UCLA Division of General Internal Medicine and Health Services Research and the study's senior author.
The researchers used insurance claims listed in the Milliman MedInsight Emerging Experience Research Database for 8.1 million patients from across all 50 states to assess utilization and spending for the two medications from January 30, 2020 to June 30, 2023.
Among the findings were:
- Nearly three million COVID-related prescriptions in outpatient settings during the study period, totaling $272 million.
- Hydroxychloroquine use peaked in March 2020 to 133% of pre-pandemic rates
- Ivermectin use surged in 2020 and throughout 2021, and by August 2021 peaked at more than 10 times higher than pre-pandemic rates
- After FDA-authorized COVID-19 medications (e.g., Paxlovid) became available, ivermectin and hydroxychloroquine use dropped by 93% in outpatient settings from March 1, 2022 to June 30, 2023.
- Of the estimated $272 million spent for COVID-19-related hydroxychloroquine and ivermectin, approximately $18 million was spent after March 2022 when FDA-authorized COVID medications became available.
- Limited availability of COVID-19 medications does not appear to explain the wide geographic variation in ivermectin prescribing, particularly in the South.
There are some limitations to the study. The cohort included what is called a "convenience sample," meaning that the researchers used data from a group that was easy, or convenient, to sample rather than randomly chosen. While the findings may thus not be generalizable, prior work confirms that the demographics in the dataset the researchers used reflect the U.S. population as a whole. In addition, medications that patients obtained without insurance or a prescription were not included in the analysis; variations in the price of ivermectin and hydroxychloroquine around the country may not have been captured in the researcher's spending estimates for the drugs. Additionally, the researchers attributed the increase in the drugs' usage rate to their utilization for COVID treatment although not all the claims in the data noted that.
"To our knowledge, this is the first study to report on trends in ivermectin and hydroxychloroquine utilization and spending in U.S. outpatient settings throughout the entire COVID-19 pandemic. This utilization represents wasteful spending and potentially avoidable harm. Our findings highlight the complex drivers of non-evidence based care, particularly in a time of uncertainty and distress. Multilevel efforts to enhance equitable, high-value care while minimizing non-evidence-based care are needed," said Dr. Michelle Rockwell, the study's lead author and assistant professor of family & community medicine at Virginia Tech Carilion School of Medicine.
Study co-authors included Sitaram Vangala and Dr. Katherine Kahn of UCLA; Jonathan Cantor and Cheryl Damberg of RAND Corporation; Michael Hadfield, Dale Skinner and Melody Craff of Milliman MedInsight, and Dr. A. Mark Fendrick of the University of Michigan.
This study was funded by the Commonwealth Fund, the National Center for Advancing Translational Sciences, National Institutes of Health (KL2TR003016 and UL1TR003015), and the National Institute on Aging/National Institutes of Health (K76AG064392).
