[Cardiologists and limitations of statins reimbursement]. / I cardiologi e la limitazione della rimborsabilità delle statine.

BACKGROUND: In Italy of five approved HMG-CoA reductase inhibitors (atorvastatin, cerivastatin, fluvastatin, pravastatin, and simvastatin) only the last two are reimbursed by the National Health System for secondary prevention of coronary artery disease. METHODS: During the 1999 Annual Meeting of the National Association of Hospital Cardiologists (ANMCO) a questionnaire was included in the meeting material. The aim was two-fold: 1) to evaluate whether Italian cardiologists approve the National Health System policy to reimburse only pravastatin and simvastatin for secondary prevention, and 2) to assess which end-points are considered sufficient to grant the reimbursement of additional HMG-CoA reductase inhibitors. RESULTS: Two hundred and thirty-two completed questionnaires were collected and analyzed: 90.1% (95% confidence interval-CI between 85.1 and 93.6%) of cardiologists agree that only HMG-CoA reductase inhibitors with evidence-based mortality reduction should be reimbursed in Italy for secondary prevention; 75.0% (95% CI between 69.4 and 80.6%) follow the State guidelines in order to choose the approved HMG-CoA reductase inhibitors and 69.4% (95% CI between 63.5 and 75.3%) judge that at least the demonstration of coronary artery plaque reduction should be considered as an evidence-based decision to include new HMG-CoA reductase inhibitors for reimbursement. CONCLUSIONS: Most of Italian cardiologists who answered the questionnaire agreed with the limitation of reimbursement to only HMG-CoA reductase inhibitors with evidence-based demonstration of mortality reduction and asserted that the only reduction in blood cholesterol levels should not be considered proof of efficacy.