An analysis of first authorizations for lipid-lowering drugs in Belgium.
BACKGROUND
In Belgium lipid-lowering drugs are reimbursed in primary and secondary prevention when after a non-specified diet of at least three months total cholesterol (TC) remains higher than 250 mg/dl or triglycerides (TG) remain higher than 200 mg/dl. Low-density lipoprotein cholesterol (LDL-C) is only taken into account for the reimbursement of fibrates when it remains higher than 160 mg/dl in secondary prevention. The aim of this study was to evaluate the changes in fasting lipoproteins levels among patients who wait for the reimbursement of a lipid-lowering drug. Additionally, the parameters influencing the physicians' choice to prescribe a statin or a fibrate were analysed.


METHODS
In total 286 first authorizations for the reimbursement of lipid-lowering drugs were recorded during February and March of 2002 at two regional health insurance offices. We studied a mixed primary and secondary prevention population.


RESULTS
The mean age at the initiation of the treatment was 61 years (SD = 12). Mean fasting TC was 285 mg/dl before the diet and 286 mg/dl after the diet. Fasting TC and TG did not decrease with the diet for respectively 51% and 54% of the patients. High TC and an improvement of TG during the diet were the only two factors correlated with the prescription of a statin instead of a fibrate.


CONCLUSIONS
Half of the patients receiving lipid-lowering drugs in Belgium were not able to decrease their TC with diet before the initiation of the treatment. Cardiovascular risk factors were not taken into account for the reimbursement of statins. Belgian reimbursement criteria should be adapted.
Devroey
D
D
Department of General Practice, University of Brussels, Laarbeeklaan 103, 1090 Brussels, Belgium. dirk.devroey@vub.ac.be
Betz
W
W
D000368:Aged; D001530:Belgium; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D016527:Drug Costs; D005260:Female; D017048:Health Care Costs; D006801:Humans; D006937:Hypercholesterolemia / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D000960:Hypolipidemic Agents / Q000191:economics* / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009313:National Health Programs / Q000191:economics*; D011379:Prognosis; D012051:Reimbursement Mechanisms / Q000331:legislation & jurisprudence*; D018570:Risk Assessment; D012959:Socioeconomic Factors; D016896:Treatment Outcome
D000960:Hypolipidemic Agents