The propblem with the "me-too-statin" aka. fluvastatin is that it really
doesn't work that well. I don't think I've got anyone on less than 80 mgm -
and I've got plenty of patients on 10 mg (who could probably even get lower
if they made a 5 mg tablet) of simvastatin.
But maybe that's OK if one only needs to reduce the 5 yr risk from 12% (a
worry) to 8% (less of a worry) - certainly fluvastatin is the cheapest
option (and it wouldn't be selling that well if it wasn't so cheap ......)
JW
-----Original Message-----
From: Jeff Green <[log in to unmask]>
To: Chris Burton <[log in to unmask]>; [log in to unmask]
<[log in to unmask]>
Date: Monday, March 23, 1998 10:32 AM
Subject: Re: Statins for everyone
>>Jeff
>>
>>Statins available on Private Prescription - if outside a chosen few
>>criteria?
>
>>1. pretty dodgy in regard of terms of service as still need to be NHS
>>prescribable for many patients
>Place it in a similar position to antimalarials. The antimalarials are
>allowed on the NHS to treat malaria, but on private prescription for
>prophylaxis. The quick and dirty solution would be statins on the NHS
>post MI and available on a private script (or OTC?) as primary prophylaxis.
>
>>2. needs monitoring on ongoing basis - private fee for this too?
>If you like.
>
>
>>3. isn't this two tier medicine by the back door,
>Yes. But if the patient was to see a private consultant who asked you
>prescribe
>a statin, would you?
>Should single tier medicine be sustained if it means the secret denial of
>treatment
>for those who can afford it?
>> requiring a complete
>>rewrite of several sections ( and underpinning philosophy) of TOS?
>
>I don't know enough about GP's TOS to comment.
>
>>4. but isn't the health gain from pravastatin 40mg daily ( for £50 per
>>month) for a 50 yr old at 15% 5 year risk greater than that from a £??
BUPA
>>subscription?
>Lets get really uncomfortable, should the NHS fund prophylaxis treatment of
>a smoker who is spending even more of their own money rushing to an early
>grave?
>
>>5. If it was *your* money would you buy endpoint trialled pravastatin for
>>£45-50 or me-too-statin for £15-20?
>
>The me-too-statin, I think it is fairly safe to assume a class action. from
>pharmacologically similar drugs (particularly since trials on three
>different
>statins have produced similar results)
>
>>More thinking the unthinkable I suspect - interested to hear what lurkers
>>think here.
>
>I'd like to know too, and by the way, the arguments I present are
>necessarily my opinions
>just questions that I believe need to be debated.
>
>Regards
>
>Jeff
>
>[log in to unmask]
>
>
>
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