The need to be clear about the affordability of JBS 2 'target chasing'
Duerden has highlighted that a number of prescribers firmly believe
that the optimum total and LDL cholesterol targets recommended in the
Joint British Societies’ revised guidelines on cardiovascular disease
prevention (JBS 2) should be adopted [1]. The affordability of doing so
seems questionable, given that it would entail giving many people
atorvastatin >20mg/day or other drugs that are more expensive than
generic simvastatin but not currently supported by outcome evidence on
cardiovascular events or mortality. If 5.2 million people in England are
now candidates for statin treatment [2] the drug cost of treating them for
1 year (using prices from the June 2006 Drug Tariff) would be:
£286 million if all take simvastatin 40mg daily
£1,096 million if half take simvastatin 40mg daily and half
atorvastatin 40mg daily.
NICE expects to issue a clinical guideline on modification of blood
lipids in December 2007. In light of JBS 2 it would be desirable to have
a clear national policy on target cholesterol concentrations much sooner.
In particular, in our view, it would be inappropriate for the cholesterol
targets in the GMS contract’s quality and outcomes framework to be brought
into line with JBS 2 targets without consideration by national policy
makers of the answers to the following questions:
- How many people taking a statin need to achieve JBS 2 cholesterol
targets rather than coronary heart disease National Service Framework
(NSF) targets to avoid one cardiovascular event or one death in a
specified period?
- What is the incremental cost per quality adjusted life year (QALY)
associated with achieving the JBS 2 cholesterol targets rather than the
NSF targets, given the available evidence on the rate of non-compliance
with statin treatment [3, 4]?
- What would be the total cost of achieving the JBS 2 cholesterol
targets rather than the NSF targets in all 5.2 million people considered
to be eligible for statin treatment and is this affordable?
2. Moon J C, Bogle R G. Switching statins. BMJ 2006; 332: 1344-5.
3. Jackevicius C A, Mamdani M, Tu J V. Adherence with statin therapy
in elderly patients with and without acute coronary syndromes. JAMA 2002;
288: 462-7.
4. Blackburn D F, Dobson R T et al. Adherence to statins, beta-
blockers and angiotensin-converting enzyme inhibitors following a first
cardiovascular event: a retrospective cohort study. Can J Cardiol 2005;
21: 485-8.
Competing interests:
All authors are tax payers and work for the NHS. CC and HM work to contain prescribing expenditure within budgets.
Competing interests:
No competing interests
21 June 2006
Christopher F Corfield
Chief Pharmacist
David Erskine, Yi Mien Koh, Helen Marlow
Hammersmith and Fulham PCT, 5-7 Parsons Green, London SW6 4UL
Rapid Response:
The need to be clear about the affordability of JBS 2 'target chasing'
Duerden has highlighted that a number of prescribers firmly believe
that the optimum total and LDL cholesterol targets recommended in the
Joint British Societies’ revised guidelines on cardiovascular disease
prevention (JBS 2) should be adopted [1]. The affordability of doing so
seems questionable, given that it would entail giving many people
atorvastatin >20mg/day or other drugs that are more expensive than
generic simvastatin but not currently supported by outcome evidence on
cardiovascular events or mortality. If 5.2 million people in England are
now candidates for statin treatment [2] the drug cost of treating them for
1 year (using prices from the June 2006 Drug Tariff) would be:
£286 million if all take simvastatin 40mg daily
£1,096 million if half take simvastatin 40mg daily and half
atorvastatin 40mg daily.
NICE expects to issue a clinical guideline on modification of blood
lipids in December 2007. In light of JBS 2 it would be desirable to have
a clear national policy on target cholesterol concentrations much sooner.
In particular, in our view, it would be inappropriate for the cholesterol
targets in the GMS contract’s quality and outcomes framework to be brought
into line with JBS 2 targets without consideration by national policy
makers of the answers to the following questions:
- How many people taking a statin need to achieve JBS 2 cholesterol
targets rather than coronary heart disease National Service Framework
(NSF) targets to avoid one cardiovascular event or one death in a
specified period?
- What is the incremental cost per quality adjusted life year (QALY)
associated with achieving the JBS 2 cholesterol targets rather than the
NSF targets, given the available evidence on the rate of non-compliance
with statin treatment [3, 4]?
- What would be the total cost of achieving the JBS 2 cholesterol
targets rather than the NSF targets in all 5.2 million people considered
to be eligible for statin treatment and is this affordable?
1. Duerden M G. Switching statins works with ‘an adequate dose’ but
not ‘target chasing’. BMJ rapid response
http://bmj.bmjjournals.com/cgi/eletters/332/7554/1344 (accessed 15 June
2006)
2. Moon J C, Bogle R G. Switching statins. BMJ 2006; 332: 1344-5.
3. Jackevicius C A, Mamdani M, Tu J V. Adherence with statin therapy
in elderly patients with and without acute coronary syndromes. JAMA 2002;
288: 462-7.
4. Blackburn D F, Dobson R T et al. Adherence to statins, beta-
blockers and angiotensin-converting enzyme inhibitors following a first
cardiovascular event: a retrospective cohort study. Can J Cardiol 2005;
21: 485-8.
Competing interests:
All authors are tax payers and work for the NHS. CC and HM work to contain prescribing expenditure within budgets.
Competing interests: No competing interests