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Rationing of more potent statins results in ‘sub-optimal care’

By Lilian Anekwe

GPs are being forced to offer 'sub-optimal care' with simvastatin purely on the basis of cost, when it is actually cost-effective to treat patients with atorvastatin or rosuvastatin instead, a new analysis reports.

Researchers found rosuvastatin was currently the most cost-effective alternative to simvastatin, because of its high potency, but that atorvastatin 80mg was likely to become so in the near future as it approaches the end of its patent.

A Pulse investigation last week found half of primary care organisations were tightening restrictions on high-cost drugs, with many refusing to fund rosuvastatin or atorvastatin. NHS Warrington has placed blocks on GP prescribing of both drugs.

But an analysis by researchers at the University of Sheffield has cast doubt on the strategy, which trusts have been implementing in line with the Department of Health's QIPP efficiency agenda.

The study, published last week in the European Journal of Cardiovascular Prevention and Rehabilitation, analysed data from 28 randomised controlled trials in acute coronary syndrome. It evaluated drug cost-effectiveness taking into account adherence and likely reduction in atorvastatin's cost when its patent expires, expected to be in November.

Rosuvastatin 40mg produced the greatest reduction in LDL-cholesterol, at 56%, followed by atorvastatin 80mg, at 52%, then simvastatin 40mg at 37%.

Using a cost-effectiveness threshold of £20,000 per quality-adjusted life year – the same as NICE's – researchers found 'if adherence levels in general practice are similar to those observed in trials, higher-dose statins would be cost-effective compared with simvastatin 40mg.'

'Using net benefits, rosuvastatin 40mg is estimated to be the most cost-effective alternative. If atorvastatin's cost is reduced in line with that observed for simvastatin, atorvastatin 80mg/day is estimated as the most cost-effective alternative.'

Study leader Roberta Ara, senior research analyst in health economics at the University of Sheffield, said: 'Our analyses show current PCO policies intended to minimise primary care acquisition costs result in sub-optimal care.'

Dr Anthony Brzezicki, a GP and prescribing lead for NHS Croydon – which will tighten restrictions on prescribing in the next year to make £1.12m in savings – said outright bans on prescribing potent statins were 'surprising'.

'At the moment PCOs are not in a position to recommend rosuvastatin but it's surprising they have gone so far as to blacklist it, because NICE makes the inference that GPs can prescribe it in some patients.'

Dr Lesley Kirkpatrick, a GP in Sheffield, said: 'Prescribing cheaply or not prescribing will not save money in the long term. Some patients cannot tolerate some statins so to ban selection is not sensible.'

A Department of Health spokesperson said PCTs should not look to make 'easy cuts'.

'There are ways to make efficiencies without cutting back on drugs which have proven to be effective. Doctors should prescribe medicines based on clinical need.'

Eur J Cardiovasc Prev Rehabil 2011. Published online 1 Apr

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