Increased National Cholesterol Education Program (NCEP) Goal Attainment

Abstract

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. Retrospective analysis. Madigan Army Medical Center (MAMC), Tacoma, Washington, USA. Men and women treated and filling their statin prescriptions at MAMC with records of statin conversion between October 1999 and April 2000 (n = 1303). 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 H)/American Diabetes Association (ADA) goals, lipid parameters, and estimated statin cost per patient attaining NCEP-ATP II/ADA goals, were analysed. 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. 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.