Showing posts with label Italy statins. Show all posts
Showing posts with label Italy statins. Show all posts

Drug Utilisation of statins in Italy

Introduction: Cardiovascular diseases remain the major cause of death in the world, with extensive public health expenditures. Lipid lowering agents are widely used for prevention, among which statins are dominant. 

The statins market is steadily expanding in Italy. 

It is however possible that some prescriptions are not justified; as well as, on the other hand, that consumption does not meet the necessary compliance. 

Confronting such questions, the present work performs a drug utilisation study of statins in Italy, according to current practices and in the perspective of the compliance to treatment. 

Materials and methods: Observational data were collected in a Health Unit located in Northern Italy, via its administrative database. Patients were considered eligible who had received at least one prescription of statins in the course of the five years period 2000-2004. 

The drug utilisation was evaluated year by year and in different ways, that is: 

1) by the RDD (Received Daily Dose), which is an indicator of the average quantity of drug actually received by a patient; 

2) by the PDD (Prescribed Daily Dose), an indicator of the intention to treat by the practitioner in charge; 

3) by the number of days of treatment per year, calculated based both on DDDs (Defined Daily Dose, i.e. the World Health Organisation standard for the daily intake of a drug) and PDDs. 

Results: 40,583 patients were recruited (mean age 61 years, 47% males). A 44% drop-out was assessed among patients in their first year of treatment. 

Average RDDs resulted generally lower than the respective DDDs, all RDDs showing a positive growth trend. The same positive trend was observed with PDDs, which, on the other side, were always higher than the respective DDDs. 

The general average value for days of treatment was 248 (when calculated based on DDDs). Also such parameter was steadily, substantially growing along the years of the observation period. 

The analysis of compliance (measured in terms of days of treatment as percent of 365 days in a year) showed that the share of patients was decreasing with a compliance until 50%, constant with a compliance 50 to 75%, and increasing with a higher compliance. Discussion and conclusions: Several studies are available where compliance is estimated with reference to one point in time (e.g. one year). 

Though valuable, this is static information. On the contrary, a potential contribution by the present study is in having analysed the drug utilisation of statins also in its dynamics, so providing data not only about levels but also about trends. 

On this issue, one could agree there is a general, positive tendency in Italy towards a more correct treatment practice; this is shown by drug utilisation increasing levels, which are approaching those recommended for therapeutical efficacy.

Drug utilisation of statins in Italy. Available from: https://www.researchgate.net/publication/289348952_Drug_utilisation_of_statins_in_Italy [accessed Jul 7, 2017].


Read more

Statin usage

Britain has become the “statins capital” of Europe - and has the second highest prescribing levels in the Western world for the drugs to protect against strokes and heart attacks, an international study has found.
Last night, the former heart tsar said doctors in this country were handing out too many pills to the “worried well” and those living “indolent” lifestyles who were not prepared to take steps to improve their own health.
Increasing numbers of patients in this country have been put on statins in the last decade, amid spiralling obesity and more aggressive prescribing of the medications by family doctors, whose pay is linked to take-up of the pills among their patients.
The study by the Organisation for Economic Co-operation and Development (OECD), which examined 23 industrialised nations, found that this country has the highest levels of statins prescribing in Europe.
The pills, which cost the NHS less than 10p per patient per day, are now the most commonly prescribed medication in Britain, with eight million people on some type of anti-cholestoral drug.
Medical regulators are currently considering whether to go further and follow American guidance - which could mean a doubling in the numbers on the drugs.
Some cardiologists have suggested they should be automatically prescribed to all patients from the age of 50.
But others have said they are “disturbed” by the trend to dispense the pills ever more widely, exposing millions to potential side-effects.
Research has suggested up to one in five patients taking the drugs suffers some kind of ill-effect, including muscle aches, memory disturbance, cataracts and diabetes.
The new study says that while use of the cholesterol-lowering drugs has more than tripled across OECD countries between 2000 and 2011, levels in the UK are 40 per cent higher than average.
Britain had the highest prescribing levels of all European countries examined, with 13 per cent of the population on the drugs, in a shared position with the Slovak republic. Across all 23 OECD countries examined, only Australia had higher levels of prescribing, with 13.7 per cent of the population on statins.
Valerie Paris, an economist from the OECD’s health division, said Britain’s high place in the tables could be because GPs are given financial incentives to identify and treat heart disease as part of pay contracts which reward doctors for identifying and treating a long list so of diseases.
She said: “The question is whether these people are given advice about improving the lifestyle, or are they put quickly on to statins?”
Prof Sir Roger Boyle, Government heart tsar from 2000 to 2011, said he was concerned that too many doctors were adopting a blanket approach to the drugs, instead of targeting them closely, and offering more patients lifestyle advice.
He said: “The question is whether we are effectively targeting the statins accurately. I would like to see a rather more rigorous approach - rather than them being offered to the ‘worried well’ and giving them to people because they are 50, or 55, without a proper risk assessment.”
Prof Boyle said statins had played an important part in Britain’s battle with heart disease - with a 55 per cent reduction in deaths from heart attacks and strokes in the past eight years - but said doctors needed to do far more to convince the public to tackle unhealthy habits.
The cardiologist said: “I think we have a lot further to go in helping people make the choices to help their lifestyles - smoking, exercise and diet - the things that are actually far more difficult. We are the fattest in Europe; we have got a whole lot more to do to tackle the indolence and girth of the population.”
The former national director for heart disease said: “Statins are a very cheap and cost effective way of improving the health of the nation .. but if we were starting afresh we might not put so much emphasis on them.”
In October, an analysis published in the British Medical Journal cautioned against any expansion in prescribing.
One of its authors, Dr John D Abramson, clinical instructor of primary care, from Harvard Medical School, said wider use of statins “will benefit the pharmaceutical industry more than anyone else”.
“Instead of converting millions of people into statin customers, we should be focusing on the real factors that undeniably reduce the risk of heart disease: healthy diets, exercise and avoiding smoking,” he said.
The OECD report, Health at a Glance, says that in Germany, just seven per per cent of the population is on anti-cholesterol drugs and in France nine per cent, the study found.
The United States - where around 15 per cent of adults are currently estimated to be on statins - was not included in the research.
Maureen Talbot, Senior Cardiac Nurse at the British Heart Foundation, said: “We know that two thirds of the adult population in the UK have elevated cholesterol. Statins have been a great tool for doctors to help people who can’t lower their cholesterol level and therefore their risk of a heart attack or stroke, with positive lifestyle changes.”
Tam Fry, from the National Obesity Forum, said he feared GPs were prescribing statins too readily because it was “simpler to reach for the pad and write out a prescription” than to dole out lifestyle advice.
He said the festive season was a good time for people to take stock of their habits.
“A lot of people will have taken on twice the number of calories that they need over Christmas Day, and unless they spend an hour or two walking it off on Boxing Day it will hang around them - and that’s no good,” he said.
“The priority on Boxing Day is a to go on a walk - as brisk as you can, for as long as you can,” he added.
OBESITY
The OECD study confirms that Britain is the fattest nation in Europe – with 24.8 per cent of adults classed as obese - a body mass index of 30 or more - compared to just 12.9 per cent in France.
In the international league table, average obesity levels are 17 per cent, with the UK only exceeded by Chile, Canada, Australia, New Zealand, Mexico and the US, where 36.5 per cent of adults are obese.
DIABETES
The OECD study also shows that the UK is in the top three countries for prescribing drugs for diabetes - a disease which is often linked to high level of obesity.
Almost 8 per cent of people in the UK – around 4.5million – are on such medication, ranking just behind Finland and Germany.
The report says: “This growth can be explained by a rising prevalence of diabetes, largely liked to increases in the prevalence of obesity – a major risk factor for the development of Type-2 diabetes.”
ANTI-CHOLESTEROL DRUGS
Prescription of statins or statin-like medication, 2011
Daily doses per 1,000 people per day
1. Australia 137
2= UNITED KINGDOM 130
2= Slovakia 130
4. Belgium 122
5. Norway 116
6. Denmark 115
7. Luxembourg 112
8. Canada 109
9. Netherlands 101
10. Hungary 98
11. Finland 95
12. Slovenia 93
13= Czech Republic 92
13= France 92
15. Spain 90
16. Portugal 88
17. Iceland 80
18. Sweden 77
19. Italy 72
20. Germany 68
21. South Korea 34
22. Estonia 32
23. Chile 10
OECD AVERAGE 91
Source: OECD Health at a Glance 2013

Italy: last position both in use of statins therapy and in the sensitivity of own coronary risk assessment chart

Walley and co-workers reported that Italy has the lowest use of statins of  Europe, with
only 14.74 daily doses/1000 of population covered/day, against 23.86 in
England, 26.47 in Germany, 30.85 in France, 59.28 in Norway [1]. 


They suppose that this low use may reflect low coronary morbidity of o poor adherence of
Italian patients to statins, worse than elsewhere in Europe. 


Really, the reference to this sentence proved only that the adherence to statins is worse
in Bologna (Italy) than in Funen (Denmark), and ten years ago, from 1994 to
1996 [2].


On the contrary, national guidance and policies, could be the major causes of the
Italian situation too. In the same number of the BMJ  Raithatha and Smith reported that may people who could benefit from statins are not currently receiving them, largely for economic reason [3]. In Italy the reimbursement of the statins therapy is regulated by the Unique
Commission of Drugs (CUF). The rule number 13 of the CUF recommends the
statins treatment only for people with high global risk and recommends also to
use the Italian Risk Chart to estimate the global risk.
In a previous experience we demonstrate that the first edition of the Italian
Risk Chart[4] had a very low sensitivity, since more than 80% of patients at risk for coronary disease, so classified by the Framingham equation[5], were misdiagnosed.
To this aim, we employed the Italian chart to estimate how many subjects would
have been treated with statins in a population including 536 healthy blood
donors and 213 patients with non-insulin dependent diabetes mellitus. Results
were compared with those calculated by using the Framingham equation as
reference method and with alternative risk assessment screening methods,
including the New Zealand chart [6], the new Sheffield tables [7], the chart
of the Joint Task Force of European Societies on Coronary Prevention [8], and
criteria of the Joint British Societies [9].
Only 1,7% of a donors population and only 9,5% of a diabetic population should have
been admitted the a statins therapy, according to the chart (table). But only
a private prescription could be proposed to the other 80% of patient with high
risk.

BMJ 2004328 doi: https://doi.org/10.1136/bmj.328.7436.385 (Published 12 February 2004)Cite this as: BMJ 2004;328:385
Read more