Volume 11, Number 3, May-June 2004

Outcomes guarantee for lipid-lowering drugs: results from a novel approach to risk sharing in primary care
Stephen Chapman, Elly Reeve, David Price, Giri Rajaratnam, Richard Neary

An ‘outcomes guarantee’ was established between North Staffordshire Health Authority, North Staffordshire Hospital National Health Service (NHS) Trust, Parke-Davis (now Pfizer Ltd), and Keele University. The agreement was that if atorvastatin failed to reduce low-density lipoprotein cholesterol (LDL-C) to < 3 mmol/L among a specified percentage of the patient population, Pfizer would reimburse the healthcare provider for wasted resources. An audit and intervention programme was developed, approval was obtained from the scientific merit and ethics committee and 27 practices were recruited from Central and North Stoke primary care groups. General practitioners were free to prescribe any statin. Any financial rebate was to be determined at the study end, based on the cost differential between different doses of atorvastatin. Of 1,408 patients identified as being at risk of heart disease, 877 were prescribed statins and 669 were still taking them on completion of the study. Of these, 402 patients met LDL-C targets. All patients whose dose was titrated according to the outcomes guarantee matrix achieved target, so no refund was due. An outcomes guarantee offers an open and transparent process to work with the pharmaceutical industry on an NHS agenda.

Br J Cardiol 2004;11:205-210.

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