The cost of inadequate prescriptions for hypolipidaemic drugs. VICAF Group.
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.
Ballesteros
L C
LC
Primary Healthcare Management, Getafe, Madrid, Spain. lcabello@gapm10.insalud.es
Fernández San Martín
M I
MI
Sanz Cuesta
T
T
Escortell Mayor
E
E
López Bilbao
C
C
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
D000960:Hypolipidemic Agents