title: Statin Selection in Qatar Based on Multi-indication Pharmacotherapeutic Multi-criteria Scoring Model, and Clinician Preference.
abstract: OBJECTIVE
  Statin selection for the largest hospital formulary in Qatar is not systematic, not comparative, and does not consider the multi-indication nature of statins. There are no reports in the literature of multi-indication-based comparative scoring models of statins or of statin selection criteria weights that are based primarily on local clinicians' preferences and experiences. This study sought to comparatively evaluate statins for first-line therapy in Qatar, and to quantify the economic impact of this.
  
  
  METHODS
  An evidence-based, multi-indication, multi-criteria pharmacotherapeutic model was developed for the scoring of statins from the perspective of the main health care provider in Qatar. The literature and an expert panel informed the selection criteria of statins. Relative weighting of selection criteria was based on the input of the relevant local clinician population. Statins were comparatively scored based on literature evidence, with those exceeding a defined scoring threshold being recommended for use.
  
  
  RESULTS
  With 95% CI and 5% margin of error, the scoring model was successfully developed. Selection criteria comprised 28 subcriteria under the following main criteria: clinical efficacy, best publish evidence and experience, adverse effects, drug interaction, dosing time, and fixed dose combination availability. Outcome measures for multiple indications were related to effects on LDL cholesterol, HDL cholesterol, triglyceride, total cholesterol, and C-reactive protein. Atorvastatin, pravastatin, and rosuvastatin exceeded defined pharmacotherapeutic thresholds. Atorvastatin and pravastatin were recommended as first-line use and rosuvastatin as a nonformulary alternative. It was estimated that this would produce a 17.6% cost savings in statins expenditure. Sensitivity analyses confirmed the robustness of the evaluation's outcomes against input uncertainties.
  
  
  CONCLUSIONS
  Incorporating a comparative evaluation of statins in Qatari practices based on a locally developed, transparent, multi-indication, multi-criteria scoring model has the potential to considerably reduce expenditures on statins. Atorvastatin and pravastatin should be the first-line statin therapies in the main Qatari health care provider, with rosuvastatin as an alternative.
authors: College of Pharmacy, Qatar University, Doha, Qatar. Electronic address: daoud.a@qu.edu.qa.
authors: Daoud
authors: D
authors: Al-Badriyeh
authors: Operation Department, Hamad Medical Corporation, Doha, Qatar.
authors: Michael
authors: M
authors: Fahey
authors: Biopharmaceutics and Clinical Pharmacy Department, Faculty of Pharmacy, The University of Jordan, Amman, Jordan.
authors: Ibrahim
authors: I
authors: Alabbadi
authors: Medical Education, Hamad Medical Corporation, Doha, Qatar.
authors: Abdullatif
authors: A
authors: Al-Khal
authors: Department of Pharmacy, Heart Hospital and the National Center for Cancer Care & Research, Hamad Medical Corporation, Doha, Qatar.
authors: Manal
authors: M
authors: Zaidan
mesh_terms: D000069059:Atorvastatin; D002097:C-Reactive Protein / Q000032:analysis; D002784:Cholesterol / Q000097:blood; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000188:drug therapy; D010818:Practice Patterns, Physicians'; D017035:Pravastatin; D011780:Qatar
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002097:C-Reactive Protein; D002784:Cholesterol; D000069059:Atorvastatin; D017035:Pravastatin
keywords: Qatar; multi-criteria; multi-indication; scoring model; selection; statins