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Australian Journal of Pharmacy : April 2005
cholesterol management Trial evidence Low on cholesterol, high on compliance Statins have revolutionised the ability to lower cholesterol and thus reduce the risk of cardiovascular disease. But they come with a high PBS price tag for the taxpayer, which could be reduced if pharmacy receives a green light to monitor statin therapy compliance. KYMBERLY MARTIN reports HOLESTEROL-lowering statins are the most prescribed and the most costly medicines for the Australian Government. C According to recent data from the Department of Health and Ageing (Expen- diture and Prescriptions) 12,156,199 pre- scriptions were supplied for atorvastatin and simvastatin between July 2003 and June 2004. Government costs for atovas- tatin reached nearly $369m and $330m for simvastatin. The average cost per script including government cost and patient contribu- tions were $64.41 for atorvastatin and $67.51 for simvastatin. Given these figures, Pharmacy Guild of Australia national vice-president Kos Sclavos is calling for a monitoring system to review compliance. He said there was evidence of signifi- cant non-compliance with heavily pre- scribed medications such as atorvastatin calcium (Lipitor) and this was a concern. 248 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 APRIL 2005 Mr Sclavos was referring to a small trial carried out in south-east Queensland in 2004 when 20 pharmacies, located mainly in medical centres, monitored compliance in 240 patients. Monitoring was via print- outs of medication history with particular focus on the market leader, Lipitor. ‘What we expected to find was patients receiving 12 monthly doses but what we discovered was a high proportion of patients averaging just 10 scripts dis- pensed. Even allowing for patients having extra supplies at home, or getting scripts filled by other pharmacies, these figures indicate non-compliance is too high.’ Mr Sclavos said the results suggested that the average patient on Lipitor may be missing out on their daily medication for at least one day a week. ‘These patients have either stopped tak- ing the medication or have not informed their GP they have stopped taking the medication.’ Even putting aside the health issues with the average cost of this statin medi- cine at $60, it represented an enormous waste of taxpayer funds, Mr Sclavos said. ‘What we are talking about here is the number-one drug therapy in cholesterol medication where there appears to be evi- dence of substantial health costs being wasted. Compliance monitoring, not prescribing ‘Medication compliance is a core element of pharmacy practice. So before the doc- tors start getting alarmed, it has nothing to do with prescribing but all do with com- pliance issues pharmacy looks at routinely as part of medication reviews,’ he said. ‘The irony is that when this was dis- cussed in meetings with the AMA a year ago, some AMA members were unaware of this happening in general practice. This is extremely frustrating when pharmacy is putting so much effort into developing an efficient health team.’ According to Mr Sclavos medication compliance decreases when symptoms of non-compliance are not evident. ‘At some point we will need compliance programs for chronic therapies, especially