Effects of Guideline and Formulary Changes on Statin Prescribing in the Veterans Affairs.

Markovitz AA, Holleman RG, Hofer TP, Kerr EA, Klamerus ML, Sussman JB. Effects of Guideline and Formulary Changes on Statin Prescribing in the Veterans Affairs. Health services research. 2017 Dec 1; 52(6):1996-2017.

Related HSR&D Project(s)

• CDA 13-021 – Implementation research of benefit-based treatment for cardiovascular disease
• IIR 11-088 – Developing and Validating a Veterans Affairs Cardiac Risk Score

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Abstract:

OBJECTIVE: To compare the effects of two sequential policy changes-the addition of a high-potency statin to the Department of Veterans Affairs (VA) formulary and the release of the American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines-on VA provider prescribing. DATA SOURCES/STUDY SETTING: Retrospective analysis of 1,100,682 VA patients, 2011-2016. STUDY DESIGN: Interrupted time-series analysis of changes in prescribing of moderate-to-high-intensity statins among high-risk patients and across high-risk subgroups. We also assessed changes in prescribing of atorvastatin and other statin drugs. We estimated marginal effects (ME) of formulary and guideline changes by comparing predicted and observed statin use. DATA COLLECTION/EXTRACTION METHODS: Data from VA Corporate Data Warehouse. PRINCIPAL FINDINGS: The use of moderate-to-high-intensity statins increased by 2 percentage points following the formulary change (ME, 2.4, 95% confidence interval [CI], 2.2 to 2.6) and less than 1 percentage point following the guideline change (ME, 0.8, 95% CI, 0.6 to 0.9). The formulary change led to approximately a 12 percentage-point increase in the use of moderate-to-high-intensity atorvastatin (ME, 11.5, 95% CI, 11.3 to 11.6). The relatively greater provider response to the formulary change occurred across all patient subgroups. CONCLUSIONS: Addition of a high-potency statin to formulary affected provider prescribing more than the ACC/AHA guidelines.