Impact of a budget-restrictive (Germany) versus an incentive-driven (UK) reimbursement system on LDL-goal-achievement in statin-treated patients for secondary prevention: results of DYSIS

Abstract

Background: Statin treatment is widespread used for secondary prevention in Europe. However, there are large differences in LDL-Cholesterol (LDL-C) target achievement between European countries. Little is known about the impact of different reimbursement systems on achievement of lipid targets in clinical practice Methods: Between June 2008 and February 2009, 22,063 consecutive statin-treated outpatients were enrolled in 11 European countries and Canada (DYSIS = Dyslipidemia International Study) to assess LDL-C target achievement for secondary prevention. In outpatient treatment in Germany chronic medical treatment is restricted by budget constraints (restrictive system) whereas in the UK reimbursement is linked to treatment goal achievements (incentive system). We compared the level of LDL-C goal achievement in patients enrolled in Germany versus the UK. Results: A total of 4,260 patients were enrolled in Germany, 540 patients in the UK. Patients in Germany were older, more often female, more often had diabetes, less often were obese and less often reported sedentary lifestyle. They had a higher prevalence of cerebrovascular and peripheral artery disease but less often ischemic heart disease as compared to the patients in the UK Patients in Germany (with a restrictive reimbursement system) less often received potent statins such as atorvastatin or rosuvastatin as compared to patients in the UK. Independent of the statin used, daily dosages were significantly lower in Germany than in the UK. As a result, significantly less patients in Germany did reach the recommended treatment goal of LDL-C <100mg/dl as compared to the UK (42.0% in Germany versus 79.8% in the UK). (Tabel Presented) Conclusion: In Germany, patients treated with statins for secondary prevention received less potent statins and lower dosages as compared to the UK probably due to differences in reimbursement systems (restrictive versus incentive). This led to a much worth LDL-C goal achievement in Germany as compared to the UK.