title: Earlier translation of evidence into public subsidy may prevent morbidity and mortality: an example using statins in diabetics with normal cholesterol levels.
abstract: OBJECTIVE
  To determine the effects on cardiovascular outcomes and costs of a delay in subsidising statins for Australian normolipidaemic diabetics aged 60-79 years that occurred between 2002 and 2006.
  
  
  METHODS
  The Australian normolipidaemic diabetic population aged 60-79 with no history of coronary heart disease (CHD) or stroke was estimated from the Australian Bureau of Statistics (National Health Survey 2001 and 2002 population estimates). The number of CHD and stroke events expected to have occurred between 2002 and 2006 were estimated from the United Kingdom Prospective Diabetes Study Risk Engine. The proportion of these events that may have been prevented by the use of statins in this population was estimated using risk reduction values from the Heart Protection Study.
  
  
  RESULTS
  The target population was estimated as 186,501. In this population, 3,205 (95% confidence interval (CI) 2567, 4003) CHD events, of which 1,456 (95% CI 908, 2334) would have been fatal, could have been prevented if all patients had been treated with statins. In addition, 2,150 (95% CI 1515, 3052) ischaemic strokes could have been prevented. The net cost to the government would have been about $136 million per year over the four-year period.
  
  
  CONCLUSIONS
  Delays in the adoption of statins on the Pharmaceutical Benefits Scheme based on evidence available at the time for specific populations may have led to preventable morbidity and mortality. Implications The effects of delays in translating new evidence into public subsidies for drugs are measurable and are likely to be significant.
authors.affiliation: Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia School of Population Health, The University of Western Australia. pagemm@pagemm.com
authors.forename: Michael M
authors.initials: MM
authors.lastname: Page
authors.forename: Frank M
authors.initials: FM
authors.lastname: Sanfilippo
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Geelhoed
authors.forename: Tom G
authors.initials: TG
authors.lastname: Briffa
authors.forename: Michael S T
authors.initials: MS
authors.lastname: Hobbs
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D002784:Cholesterol / Q000097:blood*; D016001:Confidence Intervals; D003327:Coronary Disease / Q000191:economics / Q000401:mortality / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D019317:Evidence-Based Medicine; D005260:Female; D006306:Health Surveys; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D007356:Insurance, Pharmaceutical Services; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011159:Population Surveillance; D015995:Prevalence; D012307:Risk Factors; D020521:Stroke / Q000191:economics / Q000401:mortality / Q000517:prevention & control*; D013997:Time Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol