liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Prevalence of lipid abnormalities before and after introduction of lipid modifying therapy among Swedish patients with dyslipidemia (PRIMULA)
Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
Merck and Co Inc.
Merck and Co Inc.
Uppsala University.
Show others and affiliations
2010 (English)In: BMC PUBLIC HEALTH, ISSN 1471-2458, Vol. 10Article in journal (Refereed) Published
Abstract [en]

Background: Data on the prevalence of dyslipidemia and attainment of goal/normal lipid levels in a Swedish population are scarce. The objective of this study is to estimate the prevalence of dyslipidemia and attainment of goal/normal lipid levels in patients treated with lipid modifying therapy (LMT). Methods: This longitudinal retrospective observational study covers time periods before and after treatment. Data were collected from 1994-2007 electronic patient records in public primary healthcare centers in Uppsala County, Sweden. Patients were included if they had been treated with LMT and had at least one lipid abnormality indicating dyslipidemia and if complete lipid profile data were available. Thresholds levels for lipids were defined as per Swedish guidelines. Results: Among 5,424 patients included, at baseline, the prevalence of dyslipidemia (andgt;= 1 lipid abnormality) was by definition 100%, while this figure was 82% at follow-up. At baseline, 60% had elevated low-density lipoprotein (LDL-C) combined with low high-density lipoprotein (HDL-C) and/or elevated triglycerides (TG s), corresponding figure at follow-up was 36%. Low HDL-C and/or elevated TGs at follow-up remained at 69% for patients with type 2 diabetes mellitus (T2DM), 50% among patients with coronary heart disease (CHD) and 66% among patients with 10 year CHD risk andgt;20%. Of the total sample, 40% attained goal levels of LDL-C and 18% attained goal/normal levels on all three lipid parameters. Conclusions: Focusing therapy on LDL-C reduction allows 40% of patients to achieve LDL-C goal and helps reducing triglyceride levels. Almost 60% of patients experience persistent HDL-C and/or triglyceride abnormality independently of LDL-C levels and could be candidates for additional treatments.

Place, publisher, year, edition, pages
BioMed Central , 2010. Vol. 10
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-64581DOI: 10.1186/1471-2458-10-737ISI: 000285596300001OAI: oai:DiVA.org:liu-64581DiVA: diva2:392795
Note
Original Publication: Billie Pettersson, Baishali Ambegaonkar, Vasilisa Sazonov, Mats Martinell, Jan Stalhammar and Per Wandell, Prevalence of lipid abnormalities before and after introduction of lipid modifying therapy among Swedish patients with dyslipidemia (PRIMULA), 2010, BMC PUBLIC HEALTH, (10), 737. http://dx.doi.org/10.1186/1471-2458-10-737 Licensee: BioMed Central http://www.biomedcentral.com/ Available from: 2011-01-28 Created: 2011-01-28 Last updated: 2012-03-07
In thesis
1. Lipid‐modifying and glucose-lowering therapies in clinical practice: The impact of guidelines and changing reimbursement schemes
Open this publication in new window or tab >>Lipid‐modifying and glucose-lowering therapies in clinical practice: The impact of guidelines and changing reimbursement schemes
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

cardiovascular disease, which is still a major cause of death that creates large burdens to society in terms of costs and morbidity. Dyslipidemia and type 2 diabetes mellitus are the main risk factors for cardiovascular disease, and national and international guidelines recommend lipid-modifying and glucose-lowering treatments for prevention. In 2010, about 836,000 (9% of the population) and 372,000 patients respectively were treated with these therapies in Sweden.

Various pharmaceutical policies aimed at improving the efficiency of drug use have been introduced over the years. Health technology assessment (HTA) was introduced in Sweden in 2002 as a foundation for informing pricing and reimbursement decisions by the Dental and Pharmaceutical Benefits Agency (TLV). Following HTA reviews, new reimbursement schemes for lipid-modifying and glucose-lowering therapies were introduced in 2009 and 2010 respectively. To assess the impact of the changing reimbursement schemes on the use and costs of these therapies, we analyzed data from the Swedish drug registry, using a quasi-experimental design and interrupted time series analyses.

Our results showed that the new reimbursement scheme for lipid-modifying treatment had a major effect on use; following the implementation of this scheme, there was a substantial increase in both discontinuation and switching to higher doses. Conversely, the new reimbursement scheme for glucose-lowering therapies had overall only a minor effect on use. Larger savings in the lipid market were anticipated but not fully realized, while even the minor anticipated changes in costs in the glucose-lowering market were not realized due to increased costs for insulins. We found that changes in reimbursement schemes might lead to unintended effects, which should be considered before implementation. Softer demand-side policies, such as recommendations and guidelines, might be a better option under some circumstances.

Clinical and national guidelines are other policies aimed at improving quality of care and drug use. We assessed the impact of guidelines on the quality of lipid-modifying therapies, defined as proportions of patients attaining goal/normal levels according to guidelines for lipid management. A longitudinal retrospective observational study was carried out, covering time periods before and after initiation of lipid-modifying treatment. The findings show that about 40% of the patients attained the recommended low-density lipoprotein cholesterol goals following treatment, but only 18% attained goals/normal levels in all lipid parameters. Improvement in triglycerides was moderate, and low levels of high-density lipoprotein cholesterol persisted, showing only modest improvement following therapy. Treatment patterns were found to have a better degree of adherence to guidelines regarding low-density lipoprotein cholesterol as compared to other lipid parameters.

The overall objective of treatment of type 2 diabetes mellitus is to improve glycemic control without negatively affecting quality of life. Hypoglycemia is a common side effect of intensive blood glucose control, mostly seen in patients treated with insulins. Earlier studies have suggested that hypoglycemia has a negative impact on quality of life, even in patients treated with oral glucose-lowering therapies. We carried out a cross-sectional retrospective study to assess the impact of self-reported experience of hypoglycemia on quality of life in Swedish adult patients with type 2 diabetes mellitus treated with a combination of metformin and sulfonylureas. The results showed that about 40% of the patients achieved the goal of glycemic control. About 19% reported experience of moderate or more severe hypoglycemia, and these patients were found to have lower quality of life than those patients reporting no or mild hypoglycemia, as measured by EQ-5D, a generic quality of life instrument. This could be important to consider in clinical practice.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. 96 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1285
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-75545 (URN)978-91-7519-998-6 (ISBN)
Public defence
2012-03-30, Berzeliussalen, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2012-03-07 Created: 2012-03-07 Last updated: 2017-06-30Bibliographically approved

Open Access in DiVA

fulltext(317 kB)231 downloads
File information
File name FULLTEXT01.pdfFile size 317 kBChecksum SHA-512
12bc21c1250dfbbeeccdc20c99800a8f0fe4e8ddd04b29644429cca7d9931805bd1e4f5250346ec01943e212d8a44e5592bd2fabd7c0e330dceca693bffea41c
Type fulltextMimetype application/pdf

Other links

Publisher's full text

Authority records BETA

Pettersson, Billie

Search in DiVA

By author/editor
Pettersson, Billie
By organisation
Health Technology Assessment and Health EconomicsFaculty of Health Sciences
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
Total: 231 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
urn-nbn

Altmetric score

doi
urn-nbn
Total: 163 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf