title: The cost of inadequate prescriptions for hypolipidaemic drugs. VICAF Group.
abstract: BACKGROUND
  The high consumption of hypolipidaemic agents warrants the study of the costs caused by these medicines being inadequately prescribed.
  
  
  OBJECTIVE
  To quantify the economic cost generated in 1 year in primary care by inadequate (or unnecessary) prescriptions for hypolipidaemic drugs.
  
  
  METHODS
  A cross-sectional study based on hypolipidaemic drug prescriptions for a population of pensioners ordered during 1 year by 49 family physicians from 4 health areas in Madrid, Spain. Each doctor completed a data collection sheet for each patient for whom a hypolipidaemic agent was prescribed. The adequacy of each prescription was evaluated according to 2 quality levels: for level 1, it was necessary to have knowledge of the following parameters: total cholesterol level at the start of treatment, low density lipoprotein cholesterol (LDL-C) level, whether dietary intervention preceded pharmacological treatment, patient age and risk factors; for level 2, it was not necessary to have knowledge of either diet before pharmacological treatment or LDL-C levels. Inadequate expenditure was quantified by physician, by type of doctor who initiated the pharmacological treatment (the family physician, specialist, other doctor), therapeutic group and agent.
  
  
  METHODS
  Primary healthcare management of 4 public health areas.
  
  
  RESULTS
  The cost of inadequate prescriptions for hypolipidaemic drugs reached 116,480.60 US dollars ($US; 1997 values) for quality level 1 and $US37,893.37 for level 2. 12.3% of the health professionals ordered all their prescriptions inadequately (level 1). Of the total inadequate prescription expenditure, 20.4% represented treatments initiated by family physicians and 35.3% by specialists (level 1). Statins made up 78.2% of the total cost; the inadequate expenditure for this therapeutic group reached $US88,797 (level 1). Of the prescriptions for fibrates, 88% were inadequate (level 1).
  
  
  CONCLUSIONS
  In this study, 67% of prescriptions for hypolipidaemic medicines were ordered inadequately in the pensioner population, which represents a considerable pharmacological expenditure. This percentage and the mean cost per inadequate prescription was higher if a specialist was the professional initiating the treatment. Therefore, it is necessary to run pharmaceutical prescription quality programmes with both primary care physicians and specialists involved.
authors.affiliation: Primary Healthcare Management, Getafe, Madrid, Spain. lcabello@gapm10.insalud.es
authors.forename: L C
authors.initials: LC
authors.lastname: Ballesteros
authors.forename: M I
authors.initials: MI
authors.lastname: Fernández San Martín
authors.forename: T
authors.initials: T
authors.lastname: Sanz Cuesta
authors.forename: E
authors.initials: E
authors.lastname: Escortell Mayor
authors.forename: C
authors.initials: C
authors.lastname: López Bilbao
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000178:diet therapy / Q000188:drug therapy* / Q000517:prevention & control; D000960:Hypolipidemic Agents / Q000008:administration & dosage* / Q000191:economics*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics*; D012307:Risk Factors; D013030:Spain
chemical_list: D000960:Hypolipidemic Agents