title: Lipid-lowering efficacy, safety, and costs of a large-scale therapeutic statin formulary conversion program.
abstract: OBJECTIVE
  To assess the lipid-lowering efficacy, safety, and costs of a large-scale statin formulary conversion program.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  Tertiary academic medical center.
  
  
  METHODS
  A total of 980 patients consented to participate; 942 patients completed the study.
  
  
  METHODS
  Patients were converted from their current statin therapy to either cerivastatin 0.4 or 0.8 mg/day, or simvastatin 80 mg/day, using a conversion algorithm.
  
  
  RESULTS
  Efficacy and safety were evaluated at baseline and after 6 weeks of therapy; costs were also measured. Overall attainment of the National Cholesterol Education Program (NCEP) goal for low-density lipoprotein cholesterol (LDL) increased from 64.8% to 74.5% of patients (p<0.001); mean LDL decreased from 115+/-30 mg/dl to 106+/-25 mg/dl (p<0.001). Adverse events occurred in 3% of patients, and included myositis (0.6%) and increased hepatic transaminases (0.1%). Overall costs were reduced by $115/patient treatment-year.
  
  
  CONCLUSIONS
  Statin therapeutic interchange can improve lipid control at reduced costs. The possibility of uncommon but potentially serious adverse effects suggests that these programs require appropriate monitoring.
authors.affiliation: Department of Medicine, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA. allen.taylor@na.amedd.army.mil
authors.forename: A J
authors.initials: AJ
authors.lastname: Taylor
authors.forename: K
authors.initials: K
authors.lastname: Grace
authors.forename: J
authors.initials: J
authors.lastname: Swiecki
authors.forename: R
authors.initials: R
authors.lastname: Hyatt
authors.forename: H
authors.initials: H
authors.lastname: Gibbs
authors.forename: M
authors.initials: M
authors.lastname: Sheikh
authors.forename: P G
authors.initials: PG
authors.lastname: O'Malley
authors.forename: S P
authors.initials: SP
authors.lastname: Lowenthal
authors.forename: M
authors.initials: M
authors.lastname: West
authors.forename: J
authors.initials: J
authors.lastname: Spain
authors.forename: K
authors.initials: K
authors.lastname: Maneval
authors.forename: D L
authors.initials: DL
authors.lastname: Jones
mesh_terms: D000368:Aged; D000465:Algorithms; D000924:Anticholesteremic Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D004305:Dose-Response Relationship, Drug; D005572:Formularies, Hospital as Topic; D006772:Hospitals, Military / Q000191:economics; D006801:Humans; D008055:Lipids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011725:Pyridines / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D019821:Simvastatin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*
chemical_list: D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D008055:Lipids; D011725:Pyridines; D019821:Simvastatin; C086276:cerivastatin