Choosing wisely when prescribing statins

• Published in: Nederlands tijdschrift voor geneeskunde Vol. 159; p. A8695
• Main Authors: Willemsen, Annelieke E C A B, Bredie, S J H Bas, Lobo, Claudia M, van der Vlugt, Maureen J, Kramers, C
• Format: Journal Article
• Language: Dutch
• Published: Netherlands 2015
• Subjects: Atorvastatin Calcium; Cardiovascular Diseases - drug therapy; Fluorobenzenes - economics; Fluorobenzenes - pharmacokinetics; Fluorobenzenes - therapeutic use; Health Care Costs; Heptanoic Acids - economics; Heptanoic Acids - pharmacokinetics; Heptanoic Acids - therapeutic use; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - economics; Hydroxymethylglutaryl-CoA Reductase Inhibitors - pharmacokinetics; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Pyrimidines - economics; Pyrimidines - pharmacokinetics; Pyrimidines - therapeutic use; Pyrroles - economics; Pyrroles - pharmacokinetics; Pyrroles - therapeutic use; Quality of Health Care; Risk Factors; Rosuvastatin Calcium; Simvastatin - economics; Simvastatin - pharmacokinetics; Simvastatin - therapeutic use; Sulfonamides - economics; Sulfonamides - pharmacokinetics; Sulfonamides - therapeutic use
• ISSN: 0028-2162; 1876-8784

The Dutch campaign 'Verstandig kiezen', based on the American programme 'Choosing wisely', aims to improve quality in healthcare, with attention to cost control. The 'Choosing wisely'-based programme can be applied in the choice of a statin. Atorvastatin and rosuvastatin are regarded as equal choices in various guidelines regarding cardiovascular risk management. Generic atorvastatin is available, and is approximately 25 times cheaper than rosuvastatin in almost equipotent doses. Rosuvastatin provides a greater LDL reduction than atorvastatin. Patient LDL targets can usually be achieved with atorvastatin, and rosuvastatin is not needed. At group level, there are no relevant differences in adverse-events profile between both statins. Atorvastatin and rosuvastatin do have different pharmacokinetic interactions. When changing medication, good provision of information is a prerequisite for patient satisfaction and compliance. We advise use of atorvastatin instead of rosuvastatin as drug of choice when the LDL target is not reached using simvastatin. However, under specific conditions, rosuvastatin should be the treatment of choice. Efficacy and adverse effects should then be evaluated at individual patient level.