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GPs curb statins to limit drug overspend

GPs are prescribing inadequate doses of statins in an attempt to stay within their drug budgets, experts have warned.

Resistance to using higher doses has meant many patients are failing to reach target cholesterol levels despite statin therapy.

Professor Neil Poulter, professor of preventive cardiovascular medicine at Imperial College School of Medicine in London, said only 44 per cent of patients taking statins for secondary prevention were at, or below, target levels - under 5mmol/l or a 30 per cent

reduction.

Professor Poulter, vice-president of the British Hypertension Society, said despite robust trial evidence for the impact of statins on reducing morbidity and mortality, GPs were using 'inadequate' doses.

Dr John Pittard, a GP in Staines, Middlesex, and a mem- ber of the team that drew up the national service framework for coronary heart disease, said many GPs were prescribing just 10mg/day of statins, instead of the 40mg/day dose used in most of the trials, to stay within their drug budget.

Latest prescription cost analysis data from the Department of Health show the number of 10mg/day prescriptions for atorvastatin and simvastatin - the two most commonly prescribed statins - were between seven and nine times higher than for 40mg/ day (see box).

The department hopes the huge prescribing overspends seen as a result of statin prescribing will grind to a halt when simvastatin comes off patent in May.

A spokeswoman said: 'It is difficult to predict the effect that generic entry will have, but we would expect prices to reduce within the class of drugs. This will enable primary care to do more with their prescribing budgets.'

Professor Poulter said: 'The under-use of statins is compounded by the inadequate dosages of the drugs most commonly prescribed. What is worrisome is the fact the doses of the drugs used in the trials are not being used in clinical practice.

'Resistance to the use of lipid-lowering drugs has become focused on issues of cost and this, along with a hangover from prior prejudices and lack of knowledge of trial data, remains the major cause for the restricted use of statins to treat dyslipidaemia.'

Statin doses

prescribed by GPs

Millions

Atorvastatin

10mg 2.986

20mg 1.065

40mg 0.340

Simvastatin

10mg 2.629

20mg 2.227

40mg 0.373

Source: Department of Health,

Prescription Cost Analysis, England 2001

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