title: Achievement of cholesterol targets and prescribing of higher-cost statins: a cross-sectional study in general practice.
abstract: BACKGROUND
  There is conflicting evidence as to whether achievement of cholesterol targets at the population level is dependent on the choice and cost of statin.
  
  
  OBJECTIVE
  To investigate the practice-level relationship between cholesterol quality indicators in  patients with heart disease, stroke, and diabetes and prescribing of low-cost statins.
  
  
  METHODS
  Correlations and linear regression modelling of retrospective cross-sectional practice-level data with potential explanatory variables in 7909 (96.4%) general practices  in England in 2008-2009.
  
  
  METHODS
  Quality indicator data were obtained from the Information Centre and prescribing data from the NHS Business Authority. A 'cholesterol quality indicator' score was constructed by dividing the numbers of patients achieving  the target for cholesterol control of ≤5 mmol/l in stroke, diabetes, and heart disease by the numbers on each register. A 'low-cost statin' ratio score was constructed by dividing the numbers of defined daily doses of simvastatin and pravastatin by the total numbers of defined  daily doses of statins.
  
  
  RESULTS
  Simvastatin accounted for 83.3% (standard deviation [SD] = 15.7%) of low-cost statins prescribed and atorvastatin accounted for 85.7% (SD = 14.8%) of high-cost statins prescribed. The mean cholesterol score was 73.7% (SD = 6.0%). Practices  using a higher proportion of the low-cost statins were less successful in achieving cholesterol targets. An increase of 10% in the prescribing of low-cost statins was associated with a decrease of 0.46% in the cholesterol quality indicator score (95% confidence interval = -0.54% to -0.38%,  P<0.001).
  
  
  CONCLUSIONS
  Greater use of low-cost statins was associated with a small reduction in cholesterol control.
authors.affiliation: Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich. r.fleetcroft@uea.ac.uk
authors.forename: Robert
authors.initials: R
authors.lastname: Fleetcroft
authors.forename: Peter
authors.initials: P
authors.lastname: Schofield
authors.forename: Martin
authors.initials: M
authors.lastname: Duerden
authors.forename: Mark
authors.initials: M
authors.lastname: Ashworth
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000191:economics; D004739:England; D058006:General Practice / Q000191:economics*; D006331:Heart Diseases / Q000188:drug therapy / Q000191:economics; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000191:economics / Q000517:prevention & control*; D010818:Practice Patterns, Physicians' / Q000191:economics; D019984:Quality Indicators, Health Care; D020521:Stroke / Q000188:drug therapy / Q000191:economics
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors