Ongoing activities to optimize the quality and efficiency of lipid-lowering agents in the Scottish national health service: influence and implications

ABSTRACT

Background: Prescribing of lipid-lowering agents (LLAs) has increased worldwide including in Scotland with increasing prevalence of coronary heart disease, and higher dose statins have been advocated in recent years. There have also been initiatives to encourage prescribing of generic versus patented statins to save costs without compromising care. There is a need to document these initiatives and outcomes to provide future direction.

Method: Assessment of utilization (items dispensed) and expenditure of key LLAs (mainly statins) between 2001 and 2015 in Scotland alongside initiatives.

Results: Multiple interventions over the years have increased international nonproprietary name prescribing (99% for statins) and preferential prescribing of generic versus patented statins, and reduced inappropriate prescribing of ezetimibe. This resulted in a 50% reduction in expenditure of LLAs between 2001 and 2015 despite a 412% increase in utilization, increased prescribing of higher dose statins (71% in 2015) especially atorvastatin following generic availability, and reduced prescribing of ezetimibe (reduced by 72% between 2010 and 2015). As a result, the quality of prescribing has improved.

Conclusion: Generic availability coupled with multiple measures has resulted in appreciable shifts in statin prescribing behavior and reduced ezetimibe prescribing, resulting in improvements in both the quality and efficiency of prescribing.

KEYWORDS:

• Lipid lowering agents
• Scottish NHS
• expenditure
• reforms
• drug utilization

Author contributions

AL, BG, AK, RdoN and AM developed the concept of the paper with AL undertaking the initial analysis supported by AK. BG, AK, MB, SH, MR and SMS collated the information on demand-side measures both regionally and nationally in Scotland. AL and BG wrote the first draft of the paper, with all authors contributing to successive drafts before submission. BG undertook the first re-write of the re-submission before all authors contributed to successive drafts before re-submission. All authors approved the final re-submission.

Declaration of Interest

M Bennie, S Hurding, M Ryan and S Macbride Stewart are all employed by NHS Scotland at the time this paper was written. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

A Leprowski was funded on a grant to Alec Morton by the University of Strathclyde under the university’s New Professors’ Fund.