Increased National Cholesterol Education Program (NCEP) Goal Attainment: Outcome Assessment of Department of Defense Conversion to Cerivastatin and Simvastatin
Susan Pitman Lowenthal
Karen C. Chung
Objective: To contain costs, the US Department of Defense instituted a mandated statin formulary conversion program, designating cerivastatin and simvastatin as the `preferred statins'. This study examines the effectiveness, safety, and statin cost effectiveness following conversion to cerivastatin and simvastatin. Design: Retrospective analysis. Setting: Madigan Army Medical Center (MAMC), Tacoma, Washington, USA. Patients: Men and women treated and filling their statin prescriptions at MAMC with records of statin conversion between October 1999 and April 2000 (n = 1303). Methods: Age, gender, and lipid parameter measurements assessed pre-conversion (earliest measurement prior to conversion) and >=21 days post-conversion were recorded. Pre- and post-conversion attainment of National Cholesterol Education Program Adult Treatment Panel II (NCEP-ATP II)/American Diabetes Association (ADA) goals, lipid parameters, and estimated statin cost per patient attaining NCEP-ATP II/ADA goals, were analysed. Results: Conversion to cerivastatin (n = 1038) elevated goal attainment (18.2%), and reduced low-density lipoprotein and cholesterol (LDL-C) levels by 15.4 mg/dl, total cholesterol (TC) by 13.5 mg/dl and triglycerides (TG) by 10.2 mg/dl, and elevated high-density lipoprotein and cholesterol (HDL-C) levels by 3.8 mg/dl (all p < 0.002). Similar results occurred in NCEP-ATP II patient subgroups [secondary prevention; primary prevention: with diabetes mellitus, >=2 risk factors (RF), and <2 RF]. Patients receiving simvastatin (n = 265) exhibited improvement in NCEP-ATP II/ADA goal attainment and LDL-C, TC, and HDL-C levels [all p < 0.05, except HDL-C in the <2 RF subgroup (nonsignificant)]. The estimated pre-conversion annual pharmacy statin cost per patient attaining and NCEP-ATP II/ADA goals was $US681 ($US56.77 per patient per month), compared with the post-conversion annual cost of $US355 ($US29.62 per patient per month), driven primarily by the cerivastatin conversion (2000 values). Post-conversion adverse events [rash (n = 3), dizziness (n = 1), and gastrointestinal upset (n = 1)] were rare. There were no reported clinically significant elevations of liver function tests or creatine kinase, or cases of myositis or myalgia. Conclusions: Statin conversion at MAMC to cerivastatin and simvastatin is an effective and well tolerated method for improving NCEP-ATP II/ADA goal attainment and lipid parameters while containing pharmacy costs.
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