A research team led by Juliet Usher-Smith from the University of Cambridge, and Professor Mike Kirby from The Hertfordshire Primary Care Research Network looked at the clinical and financial implications of switching 185 patients at a family doctors’ practice to more cost-effective drugs.
The switch, at the practice in Hertfordshire, UK, was carried out at the request of the local Primary Care Trust, which funds family doctors in the area.
No adverse events were reported by either patient group and the researchers argue that if the £26,000 annual savings were replicated elsewhere in the UK, the cost savings would be significant.
“In this study the generic drug simvastastin replaced low dose atorvastastin for high cholesterol treatment and candesartan replaced losartan for treating high blood pressure” explains Juliet Usher-Smith.
“Four months after the switch the cholesterol lowering drug was performing in line with the previous drug and the new blood pressure drug had actually resulted in a small, but significant, reduction in blood pressure.”
Patients were only switched to alternative drugs after careful screening by both the practice pharmacist and doctors to ensure that there were no clinical reasons why this shouldn’t be done. All patients were informed of the plans before new prescriptions were issued, either by letter or at regular check-ups.
122 were being prescribed the cholesterol lowering drug atorvastatin at the time of the switch. 43 were excluded by the practice pharmacist or doctors. 70 (57 per cent) were switched to simvastatin and 69 (99 per cent) stayed on the new drug once they’d switched.
The patient who was switched back to atorvastatin reported experiencing visual symptoms at night on simvastatin.
The clinical outcome ten months after the switch was positive. There was no significant change in blood cholesterol levels and no new diagnoses of ischaemic heart disease or cerebrovascular accidents among the 69 patients who had switched.
137 patients were receiving the blood pressure drug Iosartan. 26 were excluded by the practice pharmacist or doctors and six patients said they didn’t want to switch. Of the 115 who switched to candesartan, 108 (94 per cent) stayed on the drug.
The reasons for switching back to the original blood pressure drug ranged from one case of chest tightness to patients requesting a change or feeling anxious about their treatment.
At the ten-month review, no patients had suffered adverse events related to the switch.
The authors have stressed the importance of carefully selecting patients based on sound clinical criteria and making sure that patients are happy with the switch and understand the reasons behind it.
“Indiscriminate switching policies in patients previously well controlled may have inherent risks to those patients, either as a direct result of the medication change or indirectly if the change subsequently affects their relationship with medical services or compliance” adds Juliet Usher-Smith.
“This clearly didn’t happen in this study, where patients were carefully selected and, with the exception of a few on blood pressure medication, were happy with the change. “
No adverse events were attributed to the change in medication and the net savings to the practice were significant.
By switching the medication of 185 patients, the practice saved £26,000 - just under two per cent of its annual £1.3 million drugs budget for more than 9,000 registered patients.
The savings were calculated by factoring in staff time and administration as well as drug costs.
The January issue of IJCP also includes two editorials on the paper.
“No healthcare system can afford to countenance the haemorrhaging of public funds on this scale” says Dr Rubin Minhas, a family doctor from Kent, who points out that the UK’s National Health Service is facing one of the biggest overspends in its history.
“Our predicament is shared by the United States where the addition of prescription drugs to the Medicare scheme means that taxpayers, insurers and Medicare beneficiaries could save $8.2 billion in 2007 alone if there were a move to shift statin prescribing to the lower cost generic statins.”
“The authors should be congratulated on their study, which serves as a beacon for the NHS and the wider medical community” adds Dr James Moon from the Heart Hospital, part of University College London Hospital, and Dr Richard Bogle from Experimental Medicine and Toxicology at Imperial College London.
They point out that we live in a world where “financial targets drive change” but that, in this study, the decision to switch to lower cost statins was underpinned by rational and clinically defensible evidence.
Annette Whibley | alfa
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