THE IMPACT OF REFERENCE PRICING ON CLINICAL LIPID CONTROL

Aim. Reference pricing has recently been introduced into New Zealand i n an attempt to curb rising pharmaceutical costs. Although budget savi ngs may be significant, the resulting alteration of established drug p rescriptions has the potential to cause harm. We undertook to assess t he impact of these changes in patients switching from simvastatin to f luvastatin following the introduction of reference-based pricing in Ne w Zealand. Methods. The fasting lipid profiles of 262 patients in a de fined geographic region were obtained after at least six weeks of fluv astatin therapy. These were compared to mean lipid levels obtained fro m laboratory databases for the patients while previously receiving sim vastatin. Results. There was a significant increase in total cholester ol, LDL cholesterol and triglyceride levels (p<0.01). The elevation wa s less pronounced where higher incremental doses of fluvastatin were u sed, although still significant for LDL cholesterol and total choleste rol (p<0.01). Those receiving maximal therapy with fluvastatin experie nced similar elevations in lipid as did those on lower doses. Conclusi on. The lipid elevations seen in this audit relate both to the lesser potency of fluvastatin and underdosing. In this high risk population, significant lipid elevations may conceivably produce an excess of vasc ular events. The responsibility to the taxpayer should be weighed care fully against the ethical responsibility to the individual patient and the potential to do harm. Subtherapeutic treatment may prove more cos tly than all the savings from reference pricing.