[Cardiologists and limitations of statins reimbursement].
BACKGROUND
In Italy of five approved HMG-CoA reductase inhibitors (atorvastatin, cerivastatin, fluvastatin, pravastatin, and simvastatin) only the last two are reimbursed by the National Health System for secondary prevention of coronary artery disease.


METHODS
During the 1999 Annual Meeting of the National Association of Hospital Cardiologists (ANMCO) a questionnaire was included in the meeting material. The aim was two-fold: 1) to evaluate whether Italian cardiologists approve the National Health System policy to reimburse only pravastatin and simvastatin for secondary prevention, and 2) to assess which end-points are considered sufficient to grant the reimbursement of additional HMG-CoA reductase inhibitors.


RESULTS
Two hundred and thirty-two completed questionnaires were collected and analyzed: 90.1% (95% confidence interval-CI between 85.1 and 93.6%) of cardiologists agree that only HMG-CoA reductase inhibitors with evidence-based mortality reduction should be reimbursed in Italy for secondary prevention; 75.0% (95% CI between 69.4 and 80.6%) follow the State guidelines in order to choose the approved HMG-CoA reductase inhibitors and 69.4% (95% CI between 63.5 and 75.3%) judge that at least the demonstration of coronary artery plaque reduction should be considered as an evidence-based decision to include new HMG-CoA reductase inhibitors for reimbursement.


CONCLUSIONS
Most of Italian cardiologists who answered the questionnaire agreed with the limitation of reimbursement to only HMG-CoA reductase inhibitors with evidence-based demonstration of mortality reduction and asserted that the only reduction in blood cholesterol levels should not be considered proof of efficacy.
Bobbio
M
M
Divisione Universitaria di Cardiologia, Ospedale Molinette, Torino, Firenze. marcobobbio@libero.it
Lucci
D
D
D000328:Adult; D001291:Attitude of Health Personnel; D002309:Cardiology; D003327:Coronary Disease / Q000517:prevention & control*; D005260:Female; D015276:Health Care Rationing; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use; D007349:Insurance, Health, Reimbursement; D007356:Insurance, Pharmaceutical Services; D007558:Italy; D008297:Male; D008875:Middle Aged; D012051:Reimbursement Mechanisms; D011795:Surveys and Questionnaires
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors