title: Clinical consequences following regulatory changes in respect to reimbursement of statins cost by the Icelandic Social Insurance Administration.
abstract: BACKGROUND
  On 1 March 2009, a new reimbursement system was introduced by the Ministry of Health of Iceland regarding drugs to treat hyperlipidaemia. The Social Insurance Administration was only authorised to reimburse 10 and 20 mg simvastatin unless patients were eligible to receive a medical card from the Social Insurance Administration. The purpose of this study was to evaluate the influence of this reimbursement regulation on the clinical outcome.
  
  
  METHODS
  Patients that received hyperlipidaemia treatment and were admitted to the cardiac ward were enrolled. The criteria were that the patients had been admitted 1 year prior to the regulation change and were using other statins than simvastatin.
  
  
  RESULTS
  Out of 233 eligible patients 170 (73%) reached the treatment goal before the switch. After the switch, only 126 (54%) reached their goal (p<0.05). Total cholesterol was found to be increased after the switch by a mean of 0.48 mmol/l (range 3.90-5.53 mmol/l, p<0.001). Low-density lipoprotein cholesterol increased by a mean of 0.48 mmol/l (range 1.62-3.11, p<0.001). The level of triglycerides did not change significantly. Before the introduction of the new regulations, 73% of subjects were well controlled, but after 1 March 2009, this figure dropped to 46% (37% decrease).
  
  
  CONCLUSIONS
  In order to lower costs for subsidising drugs, a switch to simvastatin from other cholesterol-lowering drugs was implemented (by the Ministry of Health of Iceland). The result was a significant and unwanted increase in cholesterol levels among patients with heart disease. The reason seems to be inaccurate prescriptions due to lack of competence among physicians and pharmacists. The use of "one drug fits all" does not comply here.
authors.affiliation: Faculty of Pharmaceutical Sciences, School of Health Science, University of Iceland, Hofsvallagata 53, Reykjavik, Iceland. sveinbj@hi.is
authors.forename: Sveinbjörn
authors.initials: S
authors.lastname: Gizurarson
authors.forename: Linda Rós
authors.initials: LR
authors.lastname: Björnsdóttir
authors.forename: Rannveig
authors.initials: R
authors.lastname: Einarsdóttir
authors.forename: Matthías
authors.initials: M
authors.lastname: Halldórsson
authors.forename: Karl
authors.initials: K
authors.lastname: Andersen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000191:economics* / Q000627:therapeutic use; D000069059:Atorvastatin; D002784:Cholesterol / Q000097:blood*; D005260:Female; D005464:Fluorobenzenes / Q000191:economics / Q000627:therapeutic use; D005500:Follow-Up Studies; D006538:Heptanoic Acids / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy*; D007055:Iceland; D008297:Male; D008875:Middle Aged; D017035:Pravastatin / Q000191:economics / Q000627:therapeutic use; D011743:Pyrimidines / Q000191:economics / Q000627:therapeutic use; D011758:Pyrroles / Q000191:economics / Q000627:therapeutic use; D012051:Reimbursement Mechanisms / Q000331:legislation & jurisprudence*; D000068718:Rosuvastatin Calcium; D019821:Simvastatin / Q000191:economics* / Q000627:therapeutic use; D012943:Social Security / Q000458:organization & administration*; D013449:Sulfonamides / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000924:Anticholesteremic Agents; D005464:Fluorobenzenes; D006538:Heptanoic Acids; D011743:Pyrimidines; D011758:Pyrroles; D013449:Sulfonamides; D000068718:Rosuvastatin Calcium; D002784:Cholesterol; D000069059:Atorvastatin; D019821:Simvastatin; D017035:Pravastatin