title: Clinical and economic outcomes in patients switched to simvastatin in a community-based family medicine practice.
abstract: BACKGROUND
  The introduction of a generic formulation of simvastatin has created the potential to provide significant low-density lipoprotein cholesterol (LDL-C) reduction in a highly cost-effective manner.
  
  
  METHODS
  This retrospective cohort analysis utilised electronic medical record data from a United States, community-based, independent physician family medicine practice. Patients switched from other statins or statin combinations to simvastatin by the family medicine physicians during routine patient care from January 2002 to October 2008 were identified. Equivalent statin dosing, lipid panel changes and National Cholesterol Education Program--Adult Treatment Panel III (NCEP) LDL-C goal attainment rates were compared preswitch and postswitch. The potential economic impact of simvastatin switching was also evaluated.
  
  
  RESULTS
  A total of 78 patients were identified, and in 76.9% of the switches, an equipotent dose of simvastatin was prescribed. All lipid fractions showed small, non-significant increases, with LDL-C having a 2.2 mg/dl (0.06 mmol/l) increase after switching (p = 0.476). NCEP LDL-C goal attainment rates were 79.5% and 78.2% before and after switching, respectively (p = 1.00). Modelled annual cost savings associated with switching were estimated at $671.99 per patient.
  
  
  CONCLUSIONS
  These results demonstrate that an independent family medicine physician practice can successfully perform statin therapeutic substitution during routine patient care. Equivalent clinical outcomes with regards to changes in lipid fractions and NCEP LDL-C goal attainment were observed in conjunction with the potential for reduced costs for patients.
authors.affiliation: Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA 19104, USA. v.willey@usp.edu
authors.forename: V J
authors.initials: VJ
authors.lastname: Willey
authors.forename: J A
authors.initials: JA
authors.lastname: Reinhold
authors.forename: K H
authors.initials: KH
authors.lastname: Willey
authors.forename: B L
authors.initials: BL
authors.lastname: Kelly
authors.forename: M J
authors.initials: MJ
authors.lastname: Cziraky
mesh_terms: D000368:Aged; D000924:Anticholesteremic Agents / Q000191:economics / Q000627:therapeutic use*; D008078:Cholesterol, LDL / Q000097:blood; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D057915:Drug Substitution / Q000191:economics*; D016568:Drugs, Generic / Q000191:economics / Q000627:therapeutic use*; D005194:Family Practice / Q000191:economics; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy* / Q000191:economics; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019821:Simvastatin / Q000191:economics / Q000627:therapeutic use*
chemical_list: D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D016568:Drugs, Generic; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019821:Simvastatin