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New Incentives for Helping Prevent Heart Disease
Health care providers who opt to participate in the Million Hearts Cardiovascular Disease Risk Reduction model will be paid for reducing the...
The results of this analysis are congruent with similar therapeutic interchange studies, which resulted in cost savings without compromising safety or efficacy.9,11 Unlike other therapeutic interchange studies, this study analyzed both safety and lipid-lowering efficacy outcomes, instead of focusing solely on changes in LDL-C lowering, total cost savings, and/or adherence.12,13 By including the entire lipid panel and liver panel into the review, this study conducted a more inclusive review of interchangeability with statins, addressing issues such as HDL-C lowering, TG changes, and liver enzyme fluctuation on conversion. There had not been a sufficient time to assess efficacy in terms of CV outcomes.
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Two adverse events alluded to therapeutic failure as a reason for discontinuing atorvastatin. In the previous ATP III lipid guidelines, therapeutic failure was achieved when patients did not reach their LDL-C goals despite appropriate titration of statin therapy.2 However, the ACC/AHA lipid guidelines have done away with lipid goals as a measurement of treatment therapy, focusing rather on evidence-based high- or moderate-intensity statin therapy that has been proven in clinical trials to reduce mortality and CV events.1 Although measurement of efficacy via lipid panel values is no longer a guideline recommendation, the results of this chart review have shown no difference in lipid values as a result of the interchange, confirming the interchangeability of rosuvastatin and atorvastatin at their equivalent doses.
Limitations
The interchange of rosuvastatin to atorvastatin was a policy change affecting all patients within the NF/SGVHS. In order to reflect true population data and more accurately predict the effects of such a policy change, this study used intention-to-treat analysis, including all patients, even patients who were found to be nonadherent. This study is also limited by sample size (N = 202). Additionally, the generalizability of these findings may be limited. The study population was mostly males aged > 65 years with an average BMI of 32.4. Researchers did not compile comorbidity, race, or concomitant medication data. Additionally, the duration of statin therapy prior to laboratory value collection was undefined.
A retrospective chart review lends itself to limitations in data collection. Medication adherence is a factor that is assumed to have a significant effect on the results of this interchange. In this review, adherence was assessed via refill history. Researchers were unable to confirm actual consumption of the medication.
Additionally, researchers did not analyze comorbid conditions, which may have had an effect on lipid panel and liver panel values. For those veterans who discontinued atorvastatin therapy, the reason for discontinuation was often not documented. Thus, researchers were unable to assess reasons for discontinuation.
Conclusion
The results generated from a review of the therapeutic exchange of rosuvastatin to atorvastatin within a veteran population affirm that the interchange was not associated with any differences in safety or lipid control, but did result in significant drug cost savings. This study provides support for health care systems considering therapeutic interchange with high-intensity statins safely and effectively.
Acknowledgements
This material is the result of work supported with resources and the use of facilities at the North Florida/South Georgia Veterans Health System in Gainesville, Florida. The authors would like to acknowledge Kim Hoang, PharmD, for her contributions to this project.
Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.