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Lipid-lowering efficacy, safety, and costs of a large-scale therapeutic statin formulary conversion program
A J Taylor1, K Grace, J Swiecki
1Department of Medicine, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA. allen.taylor@na.amedd.army.mil
Study Objective:
To assess the lipid-lowering efficacy, safety, and costs of a large-scale statin formulary conversion program.
Design:
Prospective, observational study.
Setting:
Tertiary academic medical center.
Patients:
A total of 980 patients consented to participate; 942 patients completed the study.
Intervention:
Patients were converted from their current statin therapy to either cerivastatin 0.4 or 0.8 mg/day, or simvastatin 80 mg/day, using a conversion algorithm.
Measurements And Main Results:
Efficacy and safety were evaluated at baseline and after 6 weeks of therapy; costs were also measured. Overall attainment of the National Cholesterol Education Program (NCEP) goal for low-density lipoprotein cholesterol (LDL) increased from 64.8% to 74.5% of patients (p<0.001); mean LDL decreased from 115+/-30 mg/dl to 106+/-25 mg/dl (p<0.001). Adverse events occurred in 3% of patients, and included myositis (0.6%) and increased hepatic transaminases (0.1%). Overall costs were reduced by $115/patient treatment-year.
Conclusion:
Statin therapeutic interchange can improve lipid control at reduced costs. The possibility of uncommon but potentially serious adverse effects suggests that these programs require appropriate monitoring.