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[Cardiologists and limitations of statins reimbursement]
1Divisione Universitaria di Cardiologia, Ospedale Molinette, Torino, Firenze. marcobobbio@libero.it
Insights
Italian cardiologists support limiting reimbursement for cholesterol-lowering drugs to those proven to reduce mortality. They believe evidence of plaque reduction is key for approving new HMG-CoA reductase inhibitors.
Area of Science:
- Cardiology
- Pharmacoeconomics
- Public Health Policy
Context:
- Italy's National Health System reimburses only pravastatin and simvastatin for secondary prevention of coronary artery disease.
- Five HMG-CoA reductase inhibitors are approved in Italy: atorvastatin, cerivastatin, fluvastatin, pravastatin, and simvastatin.
Purpose:
- To assess Italian cardiologists' approval of the current reimbursement policy for HMG-CoA reductase inhibitors.
- To determine the endpoints considered sufficient for reimbursing additional HMG-CoA reductase inhibitors.
Summary:
- 90.1% of surveyed cardiologists agree that only HMG-CoA reductase inhibitors with evidence-based mortality reduction should be reimbursed.
- 75.0% of cardiologists follow state guidelines for selecting reimbursed HMG-CoA reductase inhibitors.
- 69.4% believe coronary artery plaque reduction should justify reimbursement for new HMG-CoA reductase inhibitors.
Impact:
- Findings indicate strong support among Italian cardiologists for evidence-based reimbursement policies in cardiovascular disease prevention.
- The study highlights the importance of mortality reduction as a criterion for drug reimbursement, influencing future healthcare policy decisions.
Background:
In Italy of five approved HMG-CoA reductase inhibitors (atorvastatin, cerivastatin, fluvastatin, pravastatin, and simvastatin) only the last two are reimbursed by the National Health System for secondary prevention of coronary artery disease.
Methods:
During the 1999 Annual Meeting of the National Association of Hospital Cardiologists (ANMCO) a questionnaire was included in the meeting material. The aim was two-fold: 1) to evaluate whether Italian cardiologists approve the National Health System policy to reimburse only pravastatin and simvastatin for secondary prevention, and 2) to assess which end-points are considered sufficient to grant the reimbursement of additional HMG-CoA reductase inhibitors.
Results:
Two hundred and thirty-two completed questionnaires were collected and analyzed: 90.1% (95% confidence interval-CI between 85.1 and 93.6%) of cardiologists agree that only HMG-CoA reductase inhibitors with evidence-based mortality reduction should be reimbursed in Italy for secondary prevention; 75.0% (95% CI between 69.4 and 80.6%) follow the State guidelines in order to choose the approved HMG-CoA reductase inhibitors and 69.4% (95% CI between 63.5 and 75.3%) judge that at least the demonstration of coronary artery plaque reduction should be considered as an evidence-based decision to include new HMG-CoA reductase inhibitors for reimbursement.
Conclusions:
Most of Italian cardiologists who answered the questionnaire agreed with the limitation of reimbursement to only HMG-CoA reductase inhibitors with evidence-based demonstration of mortality reduction and asserted that the only reduction in blood cholesterol levels should not be considered proof of efficacy.