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GPs set for mass drug switch to atorvastatin after analysis shows price could fall by 95%

Exclusive GPs are set to be enrolled in schemes to switch patients en masse to atorvastatin in the wake of an analysis for the Government's QIPP programme finding its price could plummet by as much as 95% when it comes off patent later this year.

A report on drug efficiencies prepared by academics at Keele University for NHS West Midlands urges clinical commissioning groups to ‘seriously review' GP prescribing to take advantage of the potential ‘windfall' from the drop in price.

The advice comes as a GP and senior adviser to NICE called for GPs to begin using atorvastatin as the statin of choice in new patients as soon as the patent expires in May and to begin switching existing patients within six months. At least one CCG has already begun an active switching programme to the drug.

The Keele University analysis made a range of calculations for how much the price of atorvastatin might fall based on how much the prices of other cardiovascular drugs dropped when their patents expired.

The annual cost of atorvastatin could fall by 84% from £32,120 to £5,139 per 100 patients, based on the movement of simvastatin to category M in 2005, or by 90%, to £3,212 per 100 patients, based on the fall for clopidogrel one year after removal from category C in 2009.

Its price could eventually drop by as much as 95% to £1,606 per 100 patients if the drop is as steep as the change in price between July 2003 and November 2010 for simvastatin, which now costs £1,616 per 100 patients.

The analysis states: ‘The initial generic price of atorvastatin and the pace it will fall remain unknown, but are likely to be clearer by the October 2012 drug tariff update. CCGs will have to seriously review atorvastatin prescribing in light of the likely windfall savings.'

Professor Stephen Chapman, lead author of the report and head of the pharmacy school and medicines management department at Keele, said: ‘I would be very much looking at my current atorvastatin prescribing.'

Dr Rubin Minhas, a GP in Medway, Kent, and member of the NICE technology appraisal committee, said: ‘Atorvastatin would be the statin of choice and has the benefit of being safer at high doses. I would start putting new patients on atorvastatin from the time of the patent expiry.'

Dr Minhas, who is also clinical director of the BMJ Evidence Centre, said: ‘Continue with simvastatin prescribing for existing patients until six months after patent expiry – it can take a year for prices to fall.'

Pulse revealed earlier this month that PCTs and CCGs were struggling to achieve the daunting efficiency savings required of the NHS, and many are pinning their hopes on the patent expiry of the drug with the highest spend in primary care.

GP commissioners in County Durham have already introduced a scheme encouraging GPs to switch patients on rosuvastatin to atorvastatin before the patent expiry.

Dr David Russell, a GP in Darlington and a GP prescribing lead at NHS County Durham, said: ‘In Darlington we're actively changing patients on rosuvastatin to atorvastatin before atorvastatin comes off patent so we can make immediate savings when the price begins to drop.'

Dr Catherine A'Court, a GP in Carterton and CHD lead at NHS Oxfordshire, said: ‘We might well choose atorvastatin for primary prevention, not only because of its increased potency, but because of the convenience of morning dosing.'

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