An analysis of first authorizations for lipid-lowering drugs in Belgium

In Belgium lipid-lowering drugs are reimbursed in primary and secondary prevention when after a non-specified diet of at least three months total cholesterol (TC) remains higher than 250 mg/dl or triglycerides (TG) remain higher than 200 mg/dl. Low-density lipoprotein cholesterol (LDL-C) is only taken into account for the reimbursement of fibrates when it remains higher than 160 mg/dl in secondary prevention. The aim of this study was to evaluate the changes in fasting lipoproteins levels among patients who wait for the reimbursement of a lipid-lowering drug. Additionally, the parameters influencing the physicians' choice to prescribe a statin or a fibrate were analysed.

In total 286 first authorizations for the reimbursement of lipid-lowering drugs were recorded during February and March of 2002 at two regional health insurance offices. We studied a mixed primary and secondary prevention population.

The mean age at the initiation of the treatment was 61 years (SD = 12). Mean fasting TC was 285 mg/dl before the diet and 286 mg/dl after the diet. Fasting TC and TG did not decrease with the diet for respectively 51% and 54% of the patients. High TC and an improvement of TG during the diet were the only two factors correlated with the prescription of a statin instead of a fibrate.

Half of the patients receiving lipid-lowering drugs in Belgium were not able to decrease their TC with diet before the initiation of the treatment. Cardiovascular risk factors were not taken into account for the reimbursement of statins. Belgian reimbursement criteria should be adapted.