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Move to assess statin use on CVD risk has ‘huge workload implications'
By Nerys Hairon
NICE plans to extend statin use to up to three million further patients in a move that will have huge implications for drug costs and GP workload.
The institute wants to make statins available for preventing all cardiovascular disease rather than just CHD. It has formally requested that the Department of Health extend the remit of its technology appraisal to include CVD risk.
The move will delay the final appraisal by many months. It follows an angry reaction to the draft document, which propos-ed a limited expansion of statin use to patients at 20 per cent 10-year CHD risk or higher.
A NICE spokesperson said: ‘Many [respondents] pointed out there were other groups of people who could potentially benefit from statin therapy – ie those with a higher CVD risk.'
Cardiovascular experts said basing statin use on CVD risk would benefit patients at risk of stroke. But GPs warned of ‘huge workload implications'.
Professor Paul Durrington, member of the Joint British Societies' CVD prevention committee and professor of medicine at the University of Manchester, said: ‘I anticipate this means the appraisal will now include evidence that statins prevent stroke. To limit it to coronary prevention never made sense.'
Dr Terry John, former member of the NICE statins appraisal committee and an east London GP, welcomed the move but said more information was needed on workload implications.
A threshold of 20 per cent 10-year CVD risk – the same as in forthcoming JBS guidelines – would make an estimated three million extra patients eligible.
‘That has huge workload implications, but it would save a lot of lives,' said Dr John Ashcroft, CHD lead at Erewash PCT and deputy chair of Derbyshire LMC. ‘NICE should have done it straight-off. '
Dr Rubin Minhas, a member of the Primary Care Cardiovascular Society who gave evidence to the appraisal committee, predicted CVD risk assessment would be added to the QOF.
He added: ‘With a third of PCTs projected to be in financial deficit in the coming year, the prospect of funding a low CV risk threshold may not be welcomed by all.'
The department said it was considering the NICE request.
Widening statins guidance
• March 2000 – NSF on CHD recommends statins at 30 per cent 10-year CHD risk
• June 2005 – NICE draft appraisal recommends statin use at 20 per cent 10-year CHD risk, extending use by 1.5-2 million
• Sept 2005 – NICE asks DoH to extend remit to CVD risk, which could add a further three million adults
• Late 2005 – JBS to recommend statin therapy at 20 per cent10-year CVD risk