Generics drive undermines tough NICE cholesterol targets, analysis finds
By Nigel Praities
Tough new NICE cholesterol targets will be impossible to hit unless GPs ignore a new benchmark requiring 77% of statin use to be generic, a new analysis concludes.
The research suggests the new NICE targets for secondary prevention – of 4mmol/l total and 2mmol/l LDL cholesterol – will only be feasible with use of high-dose or high-potency statins in a substantial proportion of patients.
Chasing the targets risks busting drug budgets and raising the number of patients experiencing statin-induced side-effects, the researchers concluded.
Their observational study of 5,800 patients at one general practice found that while 70.3% of patients were hitting the QOF cholesterol target, fewer than a third were reaching the new NICE targets, which match those set by the Joint British Societies.
The low rate of target achievement occurred even though 36% of patients were on lipid-lowering drugs other than simvastatin, reported the researchers, at the British British Cardiovascular Society meeting this week.
Dr Meeta Patel, a GP at the practice in Hazelmere, Buckinghamshire, warned: ‘Tighter cholesterol control is likely to require higher doses of statins or the use of add-on therapies, which in turn may have a significant financial impact on primary care budgets or result in an increase in statin-induced side-effects.'
Dr John Pittard, a member of the Primary Care Cardiovascular Society and a GP in Staines, Middlesex, said the data showed the ‘moronic' policy to increase generic statin use to 77% – introduced by the NHS Institute for Innovation and Improvement in April - would leave GPs struggling to get patients to the new targets.
Around 30-40% of patients cannot get to these targets on simvastatin 40mg. In patients at high cardiovascular risk, this is not an area to be looking at making economies,' he said.
He explained GPs would be forced to prescribe higher doses of simvastatin to meet the targets, resulting in higher rates of statin-related side-effects. 'I would never take it myself, they would never take it, so why do we give it to patients?' he said.
Professor Mike Kirby, professor of health and human sciences at the University of Hertfordshire, said PCTs should understand the short-term costs of intensive statin treatment would be outweighed by long-term gains.
‘Commissioning groups will be keen to get patients to 4 and 2 to prevent hospital admissions, which is where the real costs come from,' he said.Simvastatin Battle over generic statins Battle over generic statins
March 2007 - Pulse survey reveals 78% of GPs feel under pressure to switch patients to cheap drugs such as simvastatin
July 2007 – Pharmaceutical industry launches legal challenge to prescribing incentive schemes
Jan 2008 – Pfizer researchers claim switching from atorvastatin to simvastatin increases the risk of all-cause death or a major cardiovascular event by 30%
April 2008 - NHS recommendeds PCT target for generic statin prescribing rises to 77%
April 2008 – Study shows practices in PCTs with high use of generic statins still hit QOF cholesterol targets1
May 2008 – Stricter cholesterol targets from NICE will increase PCT statin costs, say GPs