A better usage for anti-cholesterol treatments, the French 'Assurance Maladie' reinforces its action.
Since 2005, several measures have been designed to reduce statin treatments in the fight against the harmful form of cholesterol.
The French 'Assurance Maladie' is concerned about this issue since these treatments represent about one billion Euros per year and witnessed an increase by more than 10% per year in 2003/2004.
Since 2005 and thanks to the implementation of an agreement with the private doctors, there has been a complete reversal of the tendency.
Expenses linked to statins prescription decreased by 4.4% in 2006 and also in 2007. The monthly cost of a statin treatment has also decreased from 31 € per patient in 2002 to 23 € in 2007.
At the same time, we notice an increase of the number of cardio-vascular patients as well as statin treatments for diabetics (among others), although the annual progression rate, as far as the number of treatments are concerned, has inflected.
Finally since 2005, there has been a great development of generic drugs with a substitution rate of 90% in 2007.
The French 'Assurance maladie' confirms in an information note published in June 2008:« since 2005, medical mastering actions on statins allowed the saving of about 390 million Euros. »
However, the 'Assurance Maladie' considers that there is still an important progress margin, France still holds the first rank in Europe on the level of statin expenses per a single inhabitant (source : IMS Health Study 2006 - Germany, Spain, France, Italy and the UK)
- Follow the recommendations of the Afssaps (herein below) :
- Favour dietetic measures and low dosage of statins for "new treatments".
- Reinforce the prescription for generic drugs (45% in France, 60% in the UK and 80% in Germany).
To get better results, an information compaign has been launched targetting doctors and patients.
For doctors: three levels
- Avoid systematically prescribing statins for patients having low LDL Cholesterol and/or cardio-vascular risk, for whom hygienic and dietetic measures should be recommended as a first essential phase.
- In a second phase, choose the appropriate dosage according to the need of the patients, mainly for starting the treatment.
- Chose to prescribe generic drugs.
For patients: a brochure
« I have cholesterol but no medication. Is it usual doctor? »
Raising the awareness to the importance of hygienic and nutritional rules to reduce the harmful cholesterol and to avoid daily medication intakes.
Recommendations of The French Agency for Medical Safety of Health Products (Afssaps) on how to deal with patient suffering from dyslipidemia (March 2005)
The principal recommendations:
Source Afssaps march 2005
- Screening dyslipidemia is made through Exploration of a Lipidic Anomaly (ELA), which aim is to determine the concentrations of total Cholesterol, triglycerides, HDL-Cholesterol and LDL-Cholesterol.
- All adults must be screened but this check up must not be repeated when it is normal.
- There are five 'target' levels of LDL-Cholesterol justifying therapeutical intervention. These objectives were determined according to the function of the patient's vascular status and on the number of related cario-vadcular risk factors.
- Prescribing hypolipemiant cannot be justified for patients having a small cardio-vascular risk. Dietetic treatment shall be the basic thing in dealing with these patients.
- When the medical therapy is recommended, it is mainly through the use of statin, except in the following three cases: intolerance to statins ; LDL-cholesterol < 1 g/l associated to high triglycerides and a low HDL-cholesterol; isolated acute hypertriglyceridemia (TG > 4 g/l).
- Hypolipemiant treatment usually starts with small dosages. In case of insufficient improvement, higher dosages or even a combined therapy may be dealt with on a case per case basis. It should not be adopted at the detriment of a good tolerance or a good treatment observation.
- Assessing the efficiency of the treatment starts from 1 to 3 months into the treatment.
- Dealing with dyslipidemia must be associated with other cardio-vascular risk factors.
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For more information
For more information about cholesterol, section « pedagogy » suggested by the société française d'arthérosclérose