Increasing Prescription Length Could Cut Cardiovascular Disease Burden And Produce Savings In South Africa.
South Africa's rates of statin use are among the world's lowest, despite statins' demonstrated effectiveness for people with a high blood cholesterol level or history of cardiovascular disease. Almost 5 percent of the country's total mortality has been attributed to high cholesterol levels, fueled in part by low levels of statin adherence. Drawing upon experience elsewhere, we used a microsimulation model of cardiovascular disease to investigate the health and economic impacts of increasing prescription length from the standard thirty days to either sixty or ninety days, for South African adults on a stable statin regimen. Increasing prescription length to sixty or ninety days could save 1,694 or 2,553 lives per million adults, respectively. In addition, annual per patient costs related to cardiovascular disease would decrease by $152.41 and $210.29, respectively. Savings would largely accrue to patients in the form of time savings and reduced transportation costs, as a result of less frequent trips to the pharmacy. Increasing statin prescription length would both save resources and improve health outcomes in South Africa.
Thomas Gaziano (tgaziano@partners.org) is an assistant professor in the Cardiovascular Division of Brigham and Women's Hospital, in Boston, Massachusetts.
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Sylvia Cho is a research assistant in the Center for Health Decision Science in the Harvard T. H. Chan School of Public Health, in Boston.
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Stephen Sy is a programmer at the Center for Health Decision Science in the Harvard T. H. Chan School of Public Health.
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Ankur Pandya is an assistant professor of health policy and management at the Harvard T. H. Chan School of Public Health.
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Naomi S. Levitt is director of the Division of Diabetes and the Chronic Diseases Initiative for Africa, both at Old Groote Schuur Hospital, in Cape Town, South Africa.
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Krisela Steyn is associate director of the Chronic Diseases Initiative for Africa, at Old Groote Schuur Hospital.
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D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D017046:Cost Savings; D003362:Cost-Benefit Analysis / Q000379:methods; D003906:Developing Countries; D011307:Drug Prescriptions / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000191:economics*; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D013019:South Africa; D013997:Time Factors; D016903:Drug Monitoring
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
cardiovascular disease; cost-effectiveness; medication adherence; prescription length; statins