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Effects of HMG-COA Reductase Inhibitor Therapy on LDL Cholesterol Blood Levels in Hyperlipidemia: A Longitudinal Retrospective Anlaysis Using a Department of Defense Integrated Database.
AIR FORCE INST OF TECH WRIGHT-PATTERSONAFB OH
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Annual lipid-lowering therapy costs the Department of Defense DOD in excess of 40 million. In 1995, a new computer system was implemented nationwide to assist in tracking medical utilization in addition to performing general operations. Pharmacy, laboratory, and patient administration records were integrated. The purpose of this study was to investigate the five currently marketed HMG-CoA reductase inhibitors statins in the military beneficiary population served by this computer system in a selected area. The computer records of patients receiving statin therapy between February 1996 and April 1998 were retrospectively examined 1 to determine if statin therapy achieved reductions in low-density lipoprotein LDL cholesterol levels similar to those seen in clinical trials 2 to determine if there were any differences between the five statins in the LDL reductions observed and 3 to compare the cost- effectiveness of the five statins by using annual estimated treatment costs per one percent reduction in LDL. The perspective for the cost-effectiveness analyses was that of the military. An original sample of 4436 patients resulted in 289 final subjects meeting the criteria of being new statin users and having at least one pre- treatment and post-treatment LDL value on file. As the majority of patients received one particular statin, few comparisons could be conducted. Observed reductions in LDL for patients taking pravastatin were less than predicted by clinical trials, but with 95 percent confidence intervals, approached the predicted values. Patients who had pravastatin listed as the last statin fill had a larger reduction in LDL levels and lower estimated annual treatment costs when compared to patients who had simvastatin listed as the last statin fill. Other comparisons could not be conducted. The advantages and caveats of working with the DoD Composite Health Care System CHCS computer system are discussed.
APPROVED FOR PUBLIC RELEASE