Ongoing activities to optimize the quality and efficiency of lipid-lowering agents in the Scottish national health service: influence and implications

Axel Leporowski, Brian Godman*, Amanj Kurdi, Sean MacBride-Stewart, Margaret Ryan, Simon Hurding, Renata C.R.M. Do Nascimento, Marion Bennie, Alec Morton

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

24 Citations (Scopus)

Abstract

Background: Prescribing of lipid-lowering agents (LLAs) has increased worldwide including in Scotland with increasing prevalence of coronary heart disease, and higher dose statins have been advocated in recent years. There have also been initiatives to encourage prescribing of generic versus patented statins to save costs without compromising care. There is a need to document these initiatives and outcomes to provide future direction. Method: Assessment of utilization (items dispensed) and expenditure of key LLAs (mainly statins) between 2001 and 2015 in Scotland alongside initiatives. Results: Multiple interventions over the years have increased international nonproprietary name prescribing (99% for statins) and preferential prescribing of generic versus patented statins, and reduced inappropriate prescribing of ezetimibe. This resulted in a 50% reduction in expenditure of LLAs between 2001 and 2015 despite a 412% increase in utilization, increased prescribing of higher dose statins (71% in 2015) especially atorvastatin following generic availability, and reduced prescribing of ezetimibe (reduced by 72% between 2010 and 2015). As a result, the quality of prescribing has improved. Conclusion: Generic availability coupled with multiple measures has resulted in appreciable shifts in statin prescribing behavior and reduced ezetimibe prescribing, resulting in improvements in both the quality and efficiency of prescribing.

Original languageEnglish
Pages (from-to)655-666
Number of pages12
JournalExpert Review of Pharmacoeconomics and Outcomes Research
Volume18
Issue number6
DOIs
Publication statusPublished - 2 Nov 2018

Keywords

  • Lipid lowering agents
  • Scottish NHS
  • drug utilization
  • expenditure
  • reforms

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