Survey Reveals Lack Of Local Direction Is A Key Reason For GPs Not Implementing Nice Guidance On Ezetimibe

Results of a new survey of 500 GPs, conducted by TNS Healthcare UK one year after the publication of the NICE health technology appraisal (HTA) on ezetimibe1, show 69% of GPs are familiar with the Guidance.2 However the survey, which was sponsored by Merck Sharp & Dohme Limited and Schering-Plough Limited, reveals that, among GPs who were familiar with the Guidance, 43% said it had not affected their prescribing habits at all, with only 41% saying they had increased their prescribing of ezetimibe as result.2


When asked about local implementation of the Guidance, over half (53%) of the GPs who were familiar with the Guidance said they had not yet received local direction on its implementation in their PCT or practice.2 Of these, 60% confirmed that a lack of positive local direction on the implementation may reduce the chances of patients receiving a prescription for ezetimibe.2


Dr Stewart Findlay, Treasurer of the Primary Care Cardiovascular Society and a GP in Bishop Auckland, County Durham, commented, "NICE Guidance, such as that on ezetimibe, exists to support consistent care across the country. We do however need local prescribing protocols and support to implement this guidance at practice level. Ezetimibe offers a clear benefit to high risk patients who are not able to reach lipid targets on a statin alone. It is important that these patients have access to ezetimibe as NICE has set out."


The NICE guidance recommends ezetimibe, co-administered with a statin, as an option for patients whose cholesterol is not appropriately controlled on the initial statin, after appropriate dose titration (according to national targets) and when consideration is being given to changing from initial statin therapy to an alternative statin.1 Ezetimibe is also recommended as monotherapy for patients who would otherwise be initiated on statin therapy but who are unable to do so because of contraindications or intolerance to statin therapy.1


Significantly, the majority of GPs questioned in the survey saw a clear role for ezetimibe in managing high risk patients not achieving nationally recommended cholesterol levels on a statin, in accordance with the Guidance.2 Of the 500 GPs questioned, most (80%) said they would prescribe ezetimibe for any patients who could not tolerate a statin and were not achieving nationally recommended cholesterol levels.2 68% said they would prescribe ezetimibe for patients with type 2 diabetes not at recommended cholesterol levels. 63% were prepared to use ezetimibe for secondary prevention of cardiovascular disease and 56% for patients with familial hypercholesterolaemia (FH).2


48% of GPs who were familiar with the Guidance cited cost implications as a barrier to wider implementation of the Guidance.2 This is despite NICE stating that, once their Guidance has been formally published, the NHS is required to provide funding and resources for medicines recommended through this appraisal process, normally within 3 months.1















Dr John Pittard, a GP in Staines, Middlesex and Hospital Practitioner in Cardiology at St Peter's Chertsey commented, "It is concerning that GPs may not be prescribing ezetimibe on the basis of cost. Although NHS budgets are finite, NICE has a fundamental role in identifying the most cost effective treatment choices for clinicians to follow. This survey shows the lack of practical support to translate national guidance into GP practice with high vascular risk patients."



The full NICE Guidance on ezetimibe can be found here. (last accessed: 07/01/2009)


About Merck Sharp & Dohme and Schering-Plough


- Merck Sharp & Dohme Limited and Schering-Plough Limited are partners in the development and marketing of prescription medicines in cholesterol management.
- Merck Sharp & Dohme Limited is the UK subsidiary of Merck & Co. Inc., of Whitehouse Station, New Jersey, USA, a leading research-based pharmaceutical company that discovers, develops, manufactures and markets a wide range of innovative pharmaceutical products to improve human health.


- Schering-Plough is an innovation-driven, science-centered global health care company. Through its own biopharmaceutical research and collaborations with partners, Schering-Plough creates therapies that help save and improve lives around the world. The company applies its research-and-development platform to human prescription, animal health and consumer health care products. Schering-Plough's vision is to "Earn Trust, Every Day" with the doctors, patients, customers and other stakeholders served by its colleagues around the world. The company is based in Kenilworth, N.J., and its Web site is schering-plough.


References


1. National Institute for Clinical Excellence Technology Appraisal Guidance 132: Ezetimibe for the treatment of primary (heterozygous-familial and non-familial) hypercholesterolaemia, November 2007.

2. TNS Healthcare UK. Survey conducted November 2008. Sponsored by Merck Sharp & Dohme and Schering-Plough.


Schering-Plough