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Répásy B, Gazsó T, Elmer D, Pónusz-Kovács D, Kajos FL, Csákvári T, Kovács B, Boncz I. The long-term effect of generic price competition on the Hungarian statin market. BMC Health Serv Res 2023; 23:447. [PMID: 37147682 PMCID: PMC10163807 DOI: 10.1186/s12913-023-09431-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 04/20/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Generic competition is a vital health policy tool used in regulating the pharmaceutical market. Drug group HMG-CoA reductase (3-hydroxy-3-methyl-glutaryl-coenzyme-A reductase) inhibitors, widely known as "statins," was the first drug group in Hungary in which generic prescriptions became mandatory. Our aim is to analyze the changes in the retail and wholesale margins through the generic competition regarding "statins". METHODS Data was derived from the nationwide pharmaceutical database of the Hungarian National Health Insurance Fund Administration, the only health care financing agency in Hungary. We observed the turnover data regarding the HMG-CoA-reductase inhibitor "statins" from 2010 through 2019. As the drugs under review have a fixed price point in Hungary, we effectively calculated the margins. RESULTS In 2010, the consumer expenditure of statins was 30.7 billion HUF ($148 million), which decreased by 59%, to 12.5 billion HUF ($42.9 million) in 2019. In 2010, the annual health insurance reimbursement of statins was 23.7 billion HUF ($114 million), which underwent a 63% decrease to 8.6 billion HUF ($29.7 million) in 2019. In 2010, the DOT turnover was 287 million days, and it increased to above 346 million days for 2019, which reflects a 20% increase over the past nine years. The monthly retail margins decreased from 334 million HUF ($1.6 million), (January, 2010) to 176 million HUF ($0.61 million), (December, 2019). The monthly wholesale margins decreased from 96.3 million HUF ($0.46 million), (January, 2010) to 41.4 million HUF ($0.14 million), (December, 2019). The most significant downturn in margins was due to the introduction of the first two blind bids. The combined DOT turnover in reference to the examined 43 products consistently increased. CONCLUSIONS The decline in retail and wholesale margin and in health insurance expenditures was largely due to a reduction in the consumer price of generic medicines. DOT turnover of statins also increased significantly.
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Affiliation(s)
- Balázs Répásy
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Vörösmarty U. 3, 7621, Pécs, Hungary
| | - Tibor Gazsó
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Vörösmarty U. 3, 7621, Pécs, Hungary
| | - Diána Elmer
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Vörösmarty U. 3, 7621, Pécs, Hungary
- National Laboratory for Human Reproduction, Ifjúság Útja 20, Pécs, 7624, Hungary
| | - Dalma Pónusz-Kovács
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Vörösmarty U. 3, 7621, Pécs, Hungary
- National Laboratory for Human Reproduction, Ifjúság Útja 20, Pécs, 7624, Hungary
| | - Fanni Luca Kajos
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Vörösmarty U. 3, 7621, Pécs, Hungary
- National Laboratory for Human Reproduction, Ifjúság Útja 20, Pécs, 7624, Hungary
| | - Tímea Csákvári
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Vörösmarty U. 3, 7621, Pécs, Hungary
- National Laboratory for Human Reproduction, Ifjúság Útja 20, Pécs, 7624, Hungary
| | - Bettina Kovács
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Vörösmarty U. 3, 7621, Pécs, Hungary
| | - Imre Boncz
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Vörösmarty U. 3, 7621, Pécs, Hungary.
- National Laboratory for Human Reproduction, Ifjúság Útja 20, Pécs, 7624, Hungary.
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Boutari C, Karagiannis A, Athyros VG. Rosuvastatin and ezetimibe for the treatment of dyslipidemia and hypercholesterolemia. Expert Rev Cardiovasc Ther 2021; 19:575-580. [PMID: 34102931 DOI: 10.1080/14779072.2021.1940959] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Introduction: Statins are powerful lipid-lowering agents which reduce cardiovascular (CV)-related morbidity and mortality. However, a large proportion of patients cannot attain the target low-density lipoprotein cholesterol (LDL-C) levels, despite receiving maximally tolerated doses of high-intensity statins. Also, adherence to treatment may be reduced due to statin-induced myopathy or other side effects. For these reasons, guidelines recommend adding the cholesterol absorption inhibitor ezetimibe.Areas covered: Authors discuss the main pharmacological characteristics of rosuvastatin and ezetimibe, their lipid-lowering and pleiotropic effects, as well as the clinical effects of the fixed dose combination of these drugs when used to treat dyslipidemia.Expert opinion: The rosuvastatin/ezetimibe combination is safe and effective in patients with hypercholesterolemia or dyslipidemia with or without diabetes and with or without cardiovascular disease. This drug combination enabled higher proportions of patients to achieve recommended LDL-C goals than rosuvastatin monotherapy or the simvastatin/ezetimibe combination, without additional adverse events. Despite the lack of additional CV outcomes data and comparisons with atorvastatin/ezetimibe, rosuvastatin/ezetimibe appears as a potent and generally well-tolerated drug combination eligible for the management of hypercholesterolemia and dyslipidemia in adults. Recently, the 40 mg rosuvastatin/10 mg ezetimibe fixed combination was approved and is also evaluated.
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Affiliation(s)
- Chrysoula Boutari
- Department of Internal Medicine, Aristotle University and School of Medicine, Thessaloniki, Greece
| | - Asterios Karagiannis
- Department of Internal Medicine, Aristotle University and School of Medicine, Thessaloniki, Greece
| | - Vasilios G Athyros
- Department of Internal Medicine, Aristotle University and School of Medicine, Thessaloniki, Greece
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3
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Abstract
An increased risk of cardiovascular disease, independent of conventional risk factors, is present even at minor levels of renal impairment and is highest in patients with end-stage renal disease (ESRD) requiring dialysis. Renal dysfunction changes the level, composition and quality of blood lipids in favour of a more atherogenic profile. Patients with advanced chronic kidney disease (CKD) or ESRD have a characteristic lipid pattern of hypertriglyceridaemia and low HDL cholesterol levels but normal LDL cholesterol levels. In the general population, a clear relationship exists between LDL cholesterol and major atherosclerotic events. However, in patients with ESRD, LDL cholesterol shows a negative association with these outcomes at below average LDL cholesterol levels and a flat or weakly positive association with mortality at higher LDL cholesterol levels. Overall, the available data suggest that lowering of LDL cholesterol is beneficial for prevention of major atherosclerotic events in patients with CKD and in kidney transplant recipients but is not beneficial in patients requiring dialysis. The 2013 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Lipid Management in CKD provides simple recommendations for the management of dyslipidaemia in patients with CKD and ESRD. However, emerging data and novel lipid-lowering therapies warrant some reappraisal of these recommendations.
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4
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Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corrà U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FDR, Løchen ML, Löllgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, Bart van der Worp H, van Dis I, Verschuren WMM. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Atherosclerosis 2018; 252:207-274. [PMID: 27664503 DOI: 10.1016/j.atherosclerosis.2016.05.037] [Citation(s) in RCA: 339] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Ugo Corrà
- Societie: European Society of Cardiology (ESC)
| | | | | | - Ian Graham
- Societie: European Society of Cardiology (ESC)
| | | | | | | | | | | | - Joep Perk
- Societie: European Society of Cardiology (ESC)
| | | | - Josep Redon
- Societie: European Society of Hypertension (ESH)
| | | | - Naveed Sattar
- Societie: European Association for the Study of Diabetes (EASD)
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5
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Royo-Bordonada MÁ, Armario P, Lobos Bejarano JM, Pedro-Botet J, Villar Álvarez F, Elosua R, Brotons Cuixart C, Cortés O, Serrano B, Camafort Babkowski M, Gil Núñez A, Pérez A, Maiques A, de Santiago Nocito A, de Castro A, Alegría E, Baeza C, Herranz M, Sans S, Campos P. [Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice]. Semergen 2017; 43:295-311. [PMID: 28532894 DOI: 10.1016/j.semerg.2016.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 11/23/2016] [Indexed: 01/05/2023]
Abstract
The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.
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Affiliation(s)
| | - Pedro Armario
- Sociedad Española de Hipertensión-Liga Española de la Lucha Contra la HTA
| | | | | | | | | | | | - Olga Cortés
- Asociación Española de Pediatría de Atención Primaria
| | | | | | | | | | | | | | | | | | - Ciro Baeza
- Sociedad Española de Angiología y Cirugía Vascular
| | - María Herranz
- Federación de Asociaciones de Enfermería Comunitaria y Atención Primaria
| | - Susana Sans
- Sociedad Española de Salud Pública y Administración Sanitaria
| | - Pilar Campos
- Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, España
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6
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2016 European Guidelines on cardiovascular disease prevention in clinical practice. Int J Behav Med 2017; 24:321-419. [DOI: 10.1007/s12529-016-9583-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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7
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Royo-Bordonada MÁ, Armario P, Lobos Bejarano JM, Pedro-Botet J, Villar Álvarez F, Elosua R, Brotons Cuixart C, Cortés O, Serrano B, Camafort Babkowski M, Gil Núñez A, Pérez A, Maiques A, de Santiago Nocito A, de Castro A, Alegría E, Baeza C, Herranz M, Sans S, Campos P. [Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice]. GACETA SANITARIA 2017; 31:255-268. [PMID: 28292529 DOI: 10.1016/j.gaceta.2016.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 11/23/2016] [Indexed: 01/24/2023]
Abstract
The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.
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Affiliation(s)
| | - Pedro Armario
- Sociedad Española de Hipertensión-Liga Española de la Lucha Contra la HTA
| | | | | | | | | | | | - Olga Cortés
- Asociación Española de Pediatría de Atención Primaria
| | | | | | | | | | | | | | | | | | - Ciro Baeza
- Sociedad Española de Angiología y Cirugía Vascular
| | - María Herranz
- Federación de Asociaciones de Enfermería Comunitaria y Atención Primaria
| | - Susana Sans
- Sociedad Española de Salud Pública y Administración Sanitaria
| | - Pilar Campos
- Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, España
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8
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Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2017; 29:69-85. [PMID: 28173956 DOI: 10.1016/j.arteri.2016.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 11/23/2016] [Indexed: 01/18/2023]
Abstract
The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.
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9
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Abstract
Long-term use of statin therapy is essential to obtain clinical benefits, but adherence is often suboptimal and some patients are also reported to fail because of 'statin resistance'. The identification of PCSK9 as a key factor in the LDL clearance pathway has led to the development of new monoclonal antibodies. Here we critically review the economic evaluations published in Europe and focused on statins. We searched the PubMed database to select the studies published from July 2006 to June 2016 and finally selected 19 articles. Overall, the majority of studies were conducted from a third-party payer's viewpoint and recurred to modelling. Most studies were sponsored by industry and funding seemed to play a pivotal role in the study design. Patients resistant to LDL-C level reduction were considered only in a few studies. The place in therapy of the new class of biologic should be considered a kind of 'third line' for cholesterol-lowering, after patients have failed with restricted dietary regimens and then with current drug therapies. Otherwise they could result in hardly sustainable expenses even for developed countries.
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Affiliation(s)
- Livio Garattini
- CESAV, Centre for Health Economics, IRCCS Institute for Pharmacological Research 'Mario Negri', 24020 Ranica, Italy
| | - Anna Padula
- CESAV, Centre for Health Economics, IRCCS Institute for Pharmacological Research 'Mario Negri', 24020 Ranica, Italy
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10
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Royo-Bordonada MÁ, Armario P, Lobos Bejarano JM, Pedro-Botet J, Villar Alvarez F, Elosua R, Brotons Cuixart C, Cortés O, Serrano B, Cammafort Babkowski M, Gil Núñez A, Pérez A, Maiques A, de Santiago Nocito A, Castro A, Alegría E, Baeza C, Herranz M, Sans S, Campos P. [Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice]. HIPERTENSION Y RIESGO VASCULAR 2016; 34:24-40. [PMID: 28017552 DOI: 10.1016/j.hipert.2016.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 11/23/2016] [Indexed: 01/21/2023]
Abstract
The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.
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Affiliation(s)
- M Á Royo-Bordonada
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, España.
| | - P Armario
- Sociedad Española de Hipertensión-Liga Española de la Lucha Contra la HTA
| | | | | | | | - R Elosua
- Sociedad Española de Epidemiología
| | | | - O Cortés
- Asociación Española de Pediatría de Atención Primaria
| | - B Serrano
- Sociedad Española de Medicina y Seguridad en el Trabajo
| | | | | | - A Pérez
- Sociedad Española de Diabetes
| | - A Maiques
- Sociedad Española de Medicina de Familia y Comunitaria
| | | | - A Castro
- Sociedad Española de Cardiología
| | | | - C Baeza
- Sociedad Española de Angiología y Cirugía Vascular
| | - M Herranz
- Federación de Asociaciones de Enfermería Comunitaria y Atención Primaria
| | - S Sans
- Sociedad Española de Salud Pública y Administración Sanitaria
| | - P Campos
- Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, España
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Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, Hoes AW, Jennings CS, Landmesser U, Pedersen TR, Reiner Ž, Riccardi G, Taskinen MR, Tokgozoglu L, Verschuren WMM, Vlachopoulos C, Wood DA, Zamorano JL, Cooney MT. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J 2016; 37:2999-3058. [PMID: 27567407 DOI: 10.1093/eurheartj/ehw272] [Citation(s) in RCA: 1882] [Impact Index Per Article: 235.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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12
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Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, Hoes AW, Jennings CS, Landmesser U, Pedersen TR, Reiner Ž, Riccardi G, Taskinen MR, Tokgozoglu L, Verschuren WM, Vlachopoulos C, Wood DA, Zamorano JL. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Atherosclerosis 2016; 253:281-344. [DOI: 10.1016/j.atherosclerosis.2016.08.018] [Citation(s) in RCA: 558] [Impact Index Per Article: 69.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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13
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Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corrà U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FDR, Løchen ML, Löllgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, van der Worp HB, van Dis I, Verschuren WMM. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016; 37:2315-2381. [PMID: 27222591 PMCID: PMC4986030 DOI: 10.1093/eurheartj/ehw106] [Citation(s) in RCA: 4435] [Impact Index Per Article: 554.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Massimo F. Piepoli
- Corresponding authors: Massimo F. Piepoli, Heart Failure Unit, Cardiology Department, Polichirurgico Hospital G. Da Saliceto, Cantone Del Cristo, 29121 Piacenza, Emilia Romagna, Italy, Tel: +39 0523 30 32 17, Fax: +39 0523 30 32 20, E-mail: ,
| | - Arno W. Hoes
- Arno W. Hoes, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500 (HP Str. 6.131), 3508 GA Utrecht, The Netherlands, Tel: +31 88 756 8193, Fax: +31 88 756 8099, E-mail:
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14
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Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corrà U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FDR, Løchen ML, Löllgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, van der Worp HB, van Dis I, Verschuren WMM, De Backer G, Roffi M, Aboyans V, Bachl N, Bueno H, Carerj S, Cho L, Cox J, De Sutter J, Egidi G, Fisher M, Fitzsimons D, Franco OH, Guenoun M, Jennings C, Jug B, Kirchhof P, Kotseva K, Lip GYH, Mach F, Mancia G, Bermudo FM, Mezzani A, Niessner A, Ponikowski P, Rauch B, Rydén L, Stauder A, Turc G, Wiklund O, Windecker S, Zamorano JL. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts): Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur J Prev Cardiol 2016; 23:NP1-NP96. [PMID: 27353126 DOI: 10.1177/2047487316653709] [Citation(s) in RCA: 579] [Impact Index Per Article: 72.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Ugo Corrà
- Societies: European Society of Cardiology (ESC)
| | | | | | - Ian Graham
- Societies: European Society of Cardiology (ESC)
| | | | | | | | | | | | - Joep Perk
- Societies: European Society of Cardiology (ESC)
| | | | | | | | - Naveed Sattar
- European Association for the Study of Diabetes (EASD)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Leslie Cho
- Societies: European Society of Cardiology (ESC)
| | | | | | | | - Miles Fisher
- European Association for the Study of Diabetes (EASD)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lars Rydén
- Societies: European Society of Cardiology (ESC)
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Cosin Sales J, Fuentes Jiménez FJ, Mantilla Morató T, Ruiz E, Becerra V, Aceituno S, Ferrario MG, Lizán L, Gracia A. Coste-efectividad de rosuvastatina frente a simvastatina, atorvastatina y pitavastatina en pacientes con riesgo cardiovascular alto y muy alto en España. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2015; 27:228-38. [DOI: 10.1016/j.arteri.2014.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 10/30/2014] [Accepted: 11/05/2014] [Indexed: 10/24/2022]
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16
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Pichetti S, Sermet C, Godman B, Campbell SM, Gustafsson LL. Multilevel analysis of the influence of patients' and general practitioners' characteristics on patented versus multiple-sourced statin prescribing in France. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2013; 11:205-218. [PMID: 23609765 DOI: 10.1007/s40258-013-0014-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The French National Health Insurance and the Ministry of Health have introduced multiple reforms in recent years to increase prescribing efficiency. These include guidelines, academic detailing, financial incentives for the prescribing and dispensing of generics drugs as well as a voluntary pay-for-performance programme. However, the quality and efficiency of prescribing could be enhanced potentially if there was better understanding of the dynamics of prescribing behaviour in France. OBJECTIVE To analyse the patient and general practitioner characteristics that influence patented versus multiple-sourced statin prescribing in France. METHODOLOGY Statistical analysis was performed on the statin prescribing habits from 341 general practitioners (GPs) that were included in the IMS-Health Permanent Survey on Medical Prescription in France, which was conducted between 2009 and 2010 and involved 14,360 patients. Patient characteristics included their age and gender as well as five medical profiles that were constructed from the diagnoses obtained during consultations. These were (1) disorders of lipoprotein metabolism, (2) heart disease, (3) diabetes, (4) complex profiles and (5) profiles based on other diagnoses. Physician characteristics included their age, gender, solo or group practice, weekly workload and payment scheme. RESULTS Patient age had a statistically significant impact on statin prescribing for patients in profile 1 (disorders of lipoprotein metabolism) and profile 3 (complex profiles) with a greater number of patented statins being prescribed for the youngest patients. For instance, patients older than 76 years with a complex profile were prescribed fewer patented statins than patients aged 68-76 years old with the same medical profile (coefficient: -0.225; p = 0.0008). By contrast, regardless of the patient's age, the medical profile did not affect the probability of prescribing a patented statin except in young patients with heart diseases who were prescribed a greater number of patented statins (coefficient: 0.3992; p = 0.0007). Prescribing was also statistically influenced by physician features, e.g., older male physicians were more likely to prescribe patented statins (coefficient: 0.245; p = 0.0417) and GPs practicing in groups were more likely to prescribe multiple sourced statins (coefficient: -0.178; p = 0.0338), which is an important finding of the study. GPs with a lower workload prescribed a greater number of patented statins. CONCLUSION There is significant variability in the prescribing of different statins among patient and physician profiles as well as between solo and group practices. Consequently, there are opportunities to target demand-side measures to enhance the prescribing of multiple-sourced statins. Further studies are warranted, in particular in other therapeutic classes, to provide a counter-balance to the considerable marketing activities of pharmaceutical companies.
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Simoens S, Sinnaeve PR. Generic Atorvastatin, the Belgian Statin Market and the Cost-Effectiveness of Statin Therapy. Cardiovasc Drugs Ther 2012; 27:49-60. [DOI: 10.1007/s10557-012-6432-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Barrios V, Lobos JM, Serrano A, Brosa M, Capel M, Alvarez Sanz C. Cost-effectiveness analysis of rosuvastatin vs generic atorvastatin in Spain. J Med Econ 2012; 15 Suppl 1:45-54. [PMID: 22954062 DOI: 10.3111/13696998.2012.726674] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study was to carry out a long-term cost-effectiveness analysis of rosuvastatin compared with generic atorvastatin in the treatment of patients at high cardiovascular (CV) risk (≥ 5% Systematic COronary Risk Evaluation [SCORE]) and patients with prior cardiovascular disease (CVD) in Spain. METHODS The efficacy data from the Statin Therapies for Elevated Lipid Levels compared Across doses to Rosuvastatin (STELLAR) study were used to simulate achievement of low-density lipoprotein cholesterol targets with different doses of rosuvastatin and generic atorvastatin for an initial period of 1 year. A Markov model was used to estimate the number of CV complications, quality-adjusted life years (QALYs), and healthcare costs (lipid-lowering treatment and CV events) for up to 20 years after initial treatment. The analysis was carried out from the perspective of the Spanish National Health System, with costs (in year 2010 euros) and effects being discounted at 3% per year. RESULTS Compared with generic atorvastatin, rosuvastatin was cost-effective (cost per QALY gained of less than €30,000) for the primary prevention of CV events in high-risk patients in most sub-groups analyzed. In patients with prior CVD, rosuvastatin was cost-effective in all sub-groups of men and most sub-groups of women. Key limitations of this study were the need to extrapolate data from a single trial to long-term modeled outcomes and the absence of other treatment options in the analysis. CONCLUSIONS For the treatment of dyslipidemic patients with high CV risk, rosuvastatin is more effective than generic atorvastatin in terms of survival and quality-of-life adjusted survival, with incremental cost-effectiveness ratios within the range generally used in Spain, in most sub-populations defined by various combinations of CV risk factors.
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Simoens S. Generic and therapeutic substitution: ethics meets health economics. Int J Clin Pharm 2011; 33:469-70. [PMID: 21431935 DOI: 10.1007/s11096-011-9500-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 02/24/2011] [Indexed: 11/30/2022]
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