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GPs overspending to meet lipid target

GPs are ignoring soaring drug budget overspends to prescribe the new statin add-on drug ezetimibe (Ezetrol) in a bid to meet the challenging cholesterol-lowering targets in the quality framework.

Lipid-lowering experts believe GPs will need to prescribe ezetimibe to between 10-15 per cent of patients currently on statins to meet the quality framework target to get 60 per cent of their patients with CHD to cholesterol levels below 5mmol/l.

This will earn the average three-partner practice £1,200 in 2004/5 and £1,920 the following year.

However, ezetimibe – which lowers cholesterol by an additional 25 per cent when added to a statin – costs £26.31 for 28 10mg tablets and PCTs have predicted the bill could add up to £700,000 per trust to drug spends this year.

Studies have shown only 48 per cent of patients on a statin are hitting the target (Pulse, October 13, 2003).

Rosie Green, prescribing adviser at North Tyneside PCT, told the trust's board meeting last month that the GMS contract would result in a combined use of statins and ezetimibe in 5-10 per cent of patients, resulting in increased costs of £330,000-£660,000.

Dr Stewart Findlay, chair of Durham Dales PCT professional executive committee and a GP in Bishop Auckland, said GPs would ignore their prescribing budgets in favour of quality targets.

Some 69 per cent of patients with CHD across 12 practices in Durham Dales have met the target after patients resistant to or intolerant of statins were prescribed ezetimibe. But the success resulted in an overspend of £88,000.

Dr Findlay said: 'The driver for us now is to hit target and for GPs this is more important than our prescribing budgets.'

The Prescription Pricing Authority predicted a 'substantial increase in prescribing volume' but expected a decrease when a combination ezetimibe and statin pill is launched in about a year's time.

Dr Terry McCormack, a GP in Whitby, North Yorkshire, and deputy-chair of the Primary Care Cardiovascular Society, said: 'GPs will most likely concentrate on the GMS quality framework. We will become more aggressive in terms of lipid lowering and to achieve this we will have to use the newer statins or the older statins with ezetimibe.'

By Brian Kelly

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