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By Nerys Hairon

GPs will have to treat millions more patients with statins from next year after NICE went far further then expected in sanctioning a vast expansion in their use.

The institute's final appraisal determination places GPs firmly at the centre of a huge programme of primary prevention, with statins to be used from 20 per cent 10-year risk of cardiovascular disease.

NICE told Pulse an extra 3.3 million adults in England and Wales would be eligible for the drugs under the ruling ­ on top of 1.8 million currently treated ­ but some experts put the figure much higher.

But there is no indication of how the extra GP and nursing time will be paid for, with predictions of 100 extra patients per GP, each taking 40 minutes to risk-assess and treat.

GP cardiovascular experts hailed the move as a 'historic decision'. But others warned of 'huge workload implications' and questioned whether PCTs could afford it.

Trusts will have to find the estimated £55-82 million in drug costs by next April unless the Department of Health intervenes to give them extra time, NICE said.

The institute's appraisal, which will be published on its website this week, also removed age barriers to statin use, ruling the drugs were 'cost effective for all age groups' at the risk threshold, including over-75s. It said GPs should prescribe a drug with a 'low acquisition cost'.

NICE sparked a huge row earlier this year when its draft appraisal recommended statins at 20 per cent risk of CHD, rather than CVD, appearing to ignore the findings of its own cost-effectiveness analysis.

Dr John Ashcroft, CHD lead at Erewash PCT and a GP in Ilkeston, Derbyshire, applauded the decision to go much further, claiming it could save 20,000 lives a year.

He said: 'It's great news ­ it looks like some common sense prevails. The question is, how do you find these people and how many are there?'

Dr Terry McCormack, chair of the Primary Care Cardiovascular Society and a GP in Whitby, North Yorkshire, said: 'It's an awful lot of people. It's right it should happen, but it will have huge workload implications which will have to be funded and taken into account.'

Professor Mike Kirby, a member of the Joint British Societies and a GP in Letchworth, Hertfordshire, said: 'The only way would be to set up nurse-led clinics. The only way it's going to be possible is if it's included in the QOF.'

GPC negotiator Dr Mary Church said: 'It's the sort of thing that could make a good enhanced service.'

NICE plans to formally publish the appraisal in January with a national cost-impact report, after which PCTs will have three months to implement it.

nhairon@cmpinformation.com

Statins 'the new aspirin'

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