Minister’s promotion of statin switching proves controversial
pharmafile | January 19, 2007 | News story | |Â Â Â
The government says GPs could help save the health service £85 million a year by switching patients on branded statins to off-patent versions of the drugs.
The move has naturally provoked protest from pharma companies, but some doctors have also questioned the clinical argument that all statins are equally effective.
Increasing pressure on NHS budgets has led to a review of prescribing budgets across the country, and now large-scale switches from branded statins such as Pfizer's Lipitor and AstraZeneca's Crestor to cheaper generic statins are being carried out.
The volume of statin prescribing has increased by over 150% in the last five years and cost the NHS around £600m in 2005.
GPs in England spent £400 million on Lipitor alone in 2005, making it the country's biggest selling prescription medicine, and representing two-thirds of costs in statin prescribing.
The government says that if every PCT increased prescribing of generic pravastatin and simvastatin to 69% of cases – a level achieved by the top quarter of trusts – then nearly £85 million could be saved in a year.
Specific directions from government to doctors on what drugs to prescribe are usually considered too controversial, but in late December, health minister Andy Burnham explicitly called on GPs to switch to generics.
Burnham made it clear that as other areas of drug spending were allowed to increase – cancer drugs being the most notable – savings would have to be made elsewhere.
"As new drugs become available, the local NHS will increasingly have to look closely at the resources it spends on common treatments to ensure it is getting value for money.
"Statin prescription is one of the areas that can release the most savings which can be ploughed back into patient care," he said.
"The figures I'm publishing today show that productivity gains are already being delivered by many PCTs and demonstrate to other parts of the NHS the savings they could make."
NICE guidance published in 2006 ruled that generic statins are as effective for most patients as their branded counterparts.
But Professor Peter Weissberg, of the British Heart Foundation voiced his concerns about the switches to the BBC.
"The problem is that the two generic versions available to the NHS are not as potent as some of the newer, more expensive statins coming on to the market," he said.
"So it would not be right to have a target like this when it could put lives at risk.
"It is much better to say to doctors they should look to use generic versions but monitor a patient's reaction to see that their cholesterol is coming down."
Dr Phil Griffin, a GP in St. Albans said he was also concerned about the impact on patients.
"If you implement this policy across that population, there will be an overall increase in the risk of cardiovascular disease – and in some patients that could be very serious."
Pfizer has expressed similar concerns, but it and other pharma companies are powerless to stop the switches.
Pharmafocus first broke the news of the government's cost-cutting drive in November, with sources also suggesting other branded drugs, such as angiotensin II receptor blockers (ARBs) like MSD's Cozaar, could also be targeted.
