Abstract 14132: Impact of Pay-for-Performance (UK) Versus Budget Restricted (Germany) Reimbursement System on LDL-Goal-Achievement in Statin-Treated Patients for Secondary Prevention: Results of DYSIS
Background: Chronic statin treatment is well established for patients with dyslipidemia and high risk for cardiovascular events. Little is known about the impact of different reimbursement systems on the achievement of lipid targets in clinical practice.
Methods: From June 2008 to February 2009, 22,063 consecutive statin-treated outpatients were enrolled into DYSIS (Dyslipidemia International Study) in 11 European countries and Canada to assess the prevalence of dyslipidemia and LDL-C target achievement. In Germany medical treatment is restricted by budget constraints (restrictive system) whereas in the UK reimbursement is linked to treatment goal achievements (pay for performance). We compared the LDL-C goal achievement in patients enrolled in Germany versus those enrolled in 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, and less often reported sedentary lifestyle. They had a higher prevalence of cerebrovascular and peripheral artery disease but less often already manifest ischemic heart disease.
Patients in Germany (restrictive reimbursement system) less often received potent statins such as atorvastatin or rosuvastatin as compared to patients in the UK. Independent on the kind of statin, daily dosages used in Germany were significantly lower 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 with an incentive driven reimbursement system (42.0 % in Germany versus 79.8 % in the UK).
Conclusion: Patients with dyslipidemia and high risk for subsequent cardiovascular events received less aggressive statin treatment (lower potency and lower dosages) in Germany as compared to the UK probably due to differences in reimbursement systems (restrictive versus incentive). This led to a worse LDL-C goal achievement in Germany as compared to the UK.
- © 2013 by American Heart Association, Inc.