The Pharmaceutical Journal
Vol 278 No 7436 p96
27 January 2007

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Well managed switches can save money without affecting care

Switching patients to more cost-effective drugs for high cholesterol and high blood pressure can, when appropriately managed, lead to significant cost savings with limited impact on patient care, according to research published in the International Journal of Clinical Practice this month (2007;61:15).

Researchers report on the clinical and financial implications of switching 185 patients at a Hertfordshire GP practice from atorvastatin to simvastatin and from losartan to candesartan.

The practice support pharmacist selected patients on the practice list who were taking atorvastatin and excluded those with inadequate cholesterol control, intolerance to simvastatin or previous simvastatin use that had failed, renal impairment, and those who were also taking warfarin or amiodarone. A GP screened the remaining patients to identify additional medical conditions or administrative or social reasons why they should not be switched.

Patients taking losartan were screened for prior angiotensin-converting enzyme inhibitor use and documented side effects, and prior use of candesartan. Those with no history of ACE inhibitor use were switched to ramipril.

Patients taking atorvastatin 10mg or 20mg were changed to simvastatin 20mg or 40mg and patients taking losartan were switched to 4mg candesartan for every 25mg losartan.

In the 70 patients who switched statins no change in mean total cholesterol was observed after four months. One patient chose to switch back to atorvastatin due to side effects.

In the 115 patients who switched antihypertensives, a small reduction in blood pressure was observed after four months. Seven patients chose to switch back to losartan for non-specific reasons. No adverse events attributable to the switches were reported in either group after 10 months.

The researchers calculated a net annual saving of £26,000 by factoring in staff time and administrative, as well as drug, costs. They estimate that if these savings were replicated elsewhere in the UK it could result in a saving of £630m over five years for statin switches and £128m over three years for antihypertensive switches.