BMJ  2006;332:1513 (24 June), doi:10.1136/bmj.332.7556.1513

Letter

Switching statins

How to do it without tears and to benefit the NHS

EDITOR—Moon and Bogle discuss how switching to generic simvastatin could save money for the NHS in England.¹ The All Wales Medicines Strategy Group (AWMSG) was established in 2002 to advise the minister of health of the Wales Assembly on promoting safe and cost effective prescribing. The group considers that the promotion of generic simvastatin as the most cost effective statin of choice will greatly benefit NHS Wales. This is based on robust evidence.

General practitioners in Wales are advised that generic simvastatin should be the most cost effective statin of choice for new patients receiving statin treatment. Switching was not actively promoted as such. To help local health boards to balance their budgets, a subgroup of the AWMSG was tasked to develop the all Wales prescribing incentive scheme.

The Newport board has included generic simvastatin as an indicator in its prescribing incentive scheme in the past three years. No prescribing policy can be implemented effectively without the goodwill of general practitioners, and they must be on board. In Newport, the health board pharmacist and the general practitioner prescribing lead will visit practices to discuss the evidence that supports the switch. The health board prescribing support team can provide practices with pharmacy technicians to facilitate the switch. Currently, in Newport generic simvastatin is more than 65% of all statins prescribed and is still rising. It has saved £100 000s so far.

The evidence is that the statins do not differ in their effectiveness in lowering the morbidity and mortality in secondary prevention.² Effective dosage of statin is the key—simvastatin 40 mg daily. Clinicians will have to appraise the evidence critically to decide whether it is more important for us to base our day to day practice on patients' outcome or on biochemical targets.

Lliswerry Medical Centre, Newport, Gwent NP20 5EB lmclau{at}hotmail.com

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Competing interests: TL is general practitioner prescribing lead, Newport Local Health Board, and a member and formerly chair of the All Wales Prescribing Group.

References

1. Moon JC, Bogle RG. Switching statins. BMJ 2006;332: 1344-5. (10 June.)[Free Full Text]
2. Duerden MG. Switching statins works with "an adequate dose" but not "target-chasing." Electronic response to: Switching statins. http://bmj.bmjjournals.com/cgi/eletters/332/7554/1344?ck=nck#135339

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