Statins are one of the great success stories of preventive medicine, write James Moon and Richard Bogle. Prescriptions have increased by 30% every year in England and statins represent the largest part of the NHS drug bill (£738 million in 2004).
Statin prescribing is dominated by atorvastatin and simvastatin and over 40% of all prescribing is for atorvastatin. The majority (85%) of these prescriptions are for the lower doses of atorvastatin (10 and 20 mg). In May 2003 the UK simvastatin patent expired and in 2006 simvastatin costs six times less than atorvastatin.
This fall in price will save the NHS about £1bn in the next five years, say the authors. However, atorvastatin will remain on patent until 2011 and by simply switching from the expensive lower doses of atorvastatin to cheaper simvastatin, doctors could save a further £1 billion.
The number of statin prescriptions is set to rise sharply following the publication of new guidelines from the National Institute for Health and Clinical Excellence (NICE). These guidelines recommend that 5.2 million (14% of the adult population) should be taking statins and this will cost an extra £250m per year. If generic simvastatin was universally prescribed for these people, the costs would actually fall by £185m a year.
Several large independent studies have proven that both statins are equally safe and effective. The only important difference is cost. So, is there any justification to continue to prescribe lower doses of atorvastatin when simvastatin 40mg is so much cheaper, ask the authors?
At University College London Hospitals NHS Foundation Trust simvastatin is now the first line statin. This simple change will save the trust £80,000 a year. Switching programmes to replace lower dose atorvastatin with simvastatin are also in place in at least three London primary care trusts. These local initiatives need to be replicated nationally to realise the full economic benefits of generic simvastatin, as has happened in other European countries, say the authors.
"It is time for the United Kingdom to implement therapeutic substitution of simvastatin nationally by switching patients currently taking lower doses of atorvastatin, and prescribing generic simvastatin 40mg for new patients needing primary prevention of coronary heart disease," they write. "This policy would save £2bn, increase value for money, and release much needed resources to other areas of the NHS."
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