A means to an end: an overview of a hyperlipidemia outcomes management program

Assessing the results: phase 1 hyperlipidemia outcomes in 27 health plans

In phase 1 of this hyperlipidemia outcomes management program, characteristics of 7,619 patients treated with statins at 27 US managed care plans were determined. Nearly 40% (3,018 patients) had documented coronary heart disease (CHD). Most (65%) had at least two CHD risk factors. Hyperlipidemia treatment included simvastatin (39%), atorvastatin (25%), fluvastatin (14%), pravastatin (12%), and lovastatin (2%). On-treatment low-density lipoprotein cholesterol (LDL-C) levels were available for 79% of patients; however, only 46% had both baseline and follow-up levels recorded in their charts. Of patients for whom follow-up data were available, 3,779 (63%) achieved their target LDL-C levels as recommended by the National Cholesterol Education Program (NCEP). Target LDL-C levels were reached by 1,381 (87%) of the patients with a goal of 160 mg/dL, 1,326 (65%) of those with a goal of 130 mg/dL, and 1,072 (44%) of those with a goal of 100 mg/dL. Overall, 66% of patients who met their treatment goal and 24% of those who did not required no more than a 25% reduction in LDL-C. In contrast, 8% of patients who achieved goals and 36% of patients who did not required >40% reduction in LDL-C. Phase 1 results did not suggest any substantial difference among statins for achievement of NCEP goals or decrease in LDL-C. These results show that therapy with statins is effective for achievement of NCEP targets in most patients and that there is potential for improvement in the quality and cost-effectiveness of statin therapy with carefully planned interventions.

Lipid-lowering interventions in managed care settings

Effective screening, treatment, and follow-up of patients with elevated serum lipid levels is important because of the very strong association between this condition and coronary heart disease (CHD). Screening of patients with and without CHD for hyperlipidemia is not generally carried out properly by managed care organizations (MCOs) or in other settings. Primary and secondary prevention are inadequate in most patients with this condition; even in patients who are treated, lipid-lowering therapy is often not used to its full potential. These trends have been confirmed by findings in the first of a three-phase hyperlipidemia outcomes management program carried out at 27 US MCOs. The efficacy of lipid-lowering therapy can be enhanced by physician education and comprehensive, integrated quality improvement programs. The cost-effectiveness of such treatment can be improved by individualizing both drug and dose to achieve National Cholesterol Education Program goals at the lowest drug acquisition cost. The quality improvement program described and others like it have the potential to reduce the morbidity and mortality associated with CHD while decreasing the huge economic burden associated with this disease. Several such programs have been undertaken at MCOs, some with more success than others. Interventions and assessments of the type planned in phases 2 and 3 of this program can help to reduce the cost of lipid-lowering therapy without compromising cholesterol goal achievement.