Twice as many UK patients achieve LDL-cholesterol target levels than patients in Germany, and this may be due to a healthcare system which "rewards" rather than "punishes" GPs, new research suggests.
The study was presented at the European Society of Cardiology congress in Amsterdam by Anselm Kai Gitt of the Herzzentrum Ludwigshafen in Germany. While there are wide variations between European countries in achievement of LDL-C targets, the effect of different reimbursement systems on meeting the targets has not been known, he said.
However, a subanalysis of the Dyslipidemia International Study finds fewer patients reached the target in Germany - where chronic medical treatment is restricted by budget constraints - than in the UK, where GPs’ reimbursement is linked to achieving cholesterol targets.
All patients studied were on statin treatment, but just 42% of Germans achieved the target compared to 79.8% of UK patients. "As there are no differences in the availability of lipid-lowering drugs between both countries, the different healthcare systems might have an impact on the way patients are treated," he said.
The potent statin atorvastatin was used in 3.9% of German patients compared to 24.8% of UK patients, while the weaker simvastatin was used in 83.9% of Germans and 67.6% of UK patients, the study found. Also, daily dosages were significantly lower in Germany than in the UK, independent of the statin used.
“We found that UK patients are treated with more potent statins and higher doses. UK doctors are treating patients aggressively with statins in response to a financial incentive to reach cholesterol targets,” he said. The UK’s quality control feedback system, which requires GPs to measure cholesterol levels, may also have an impact.
In contrast, German doctors treat more conservatively, less often using potent statins and high doses which are more expensive, he said. “The bottom line is that German doctors fear a punitive system where they could be fined if they don’t stay within budget, while UK doctors get rewarded for achieving targets.”
Dr Gitt commented that while the German system was put in place to control costs, “it remains to be seen whether it will achieve this in the long term.”
“The UK system has higher short-term costs, with more GP visits, used of potent statins and high doses, but it may ultimately be more cost-effective because of fewer complications,” he added.