- Prescribing Advice for GPs - https://www.prescriber.org.uk -

Pulse challenges statin rationing

Pulse has published a report that questions the rationing of high intensity statins stating that GPs are being forced to offer 'sub-optimal care' with simvastatin purely on the basis of cost.

The article is based on the results of a meta-analysis of 28 randomised controlled trials in acute coronary syndromes (ACS) published in the European Journal of Cardiovascular Prevention & Rehabilitation. This analysis reviews relative reductions in LDL-C and uses a threshold of £20,000 per QALY to assess cost-effectiveness.

The authors of this paper conclude that, "Our analyses show that current PCT policies intended to minimize primary care drug acquisition costs result in suboptimal care".

It is important to note that this analysis is restricted to the evidence base in ACS where it is already recommended that high intensity statins are used. The Lipid Modification guideline (PDF) published by NICE recommends use of high intensity statins in patients with ACS without waiting for lipid levels to be available and after considering informed preference, co-morbidities, other drug therapy and benefits and risks of treatment.

Action: The conclusions of an analysis into patients with ACS cannot be generalised to all patients with cardiovascular disease. Clinicians should continue to implement the recommendations of the NICE Lipid Modification guideline including the use of high intensity statins in patients with ACS.