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(2)
PATIENTS SHOULD BE ALLOWED TO PAY FOR
STATINS
(1) WHAT ARE THE
BENEFITS AND HARMS OF
HRT?
(Benefits and harms associated with
hormone
replacement therapy: clinical decision
analysis)
http://bmj.com/cgi/content/full/328/7436/371
(Where are we now with hormone replacement
therapy?)
http://bmj.com/cgi/content/full/328/7436/357
Women free of menopausal symptoms should
not use
HRT, but it can help with relief of symptoms,
according
to a study in this week's BMJ.
Researchers at Leicester University carried
out a clinical
decision analysis on the benefits and
harms of HRT,
based on the best currently available
evidence. The study
population was white women in the United
Kingdom,
aged 50, with or without menopausal symptoms,
who
had used combined HRT for five years.
In women free of menopausal symptoms, their
analysis
showed a net harm associated with HRT
use, which
increased with increasing risk of breast
cancer.
However, it showed HRT to be on average
beneficial in
women with menopausal symptoms, with benefit
decreasing with increasing risk of breast
cancer.
These results agree with the recommendations
of the UK
Medicines and Healthcare Products Regulatory
Agency,
say the authors. However, overall benefits
depend highly
on the severity of symptoms and the associated
effect on
quality of life.
As such, they suggest that a decision analysis
tailored to
an individual woman is more appropriate
in clinical
practice than a population based approach.
Contact:
Keith Abrams, Professor of Medical Statistics,
Department of Health Sciences, University
of Leicester,
UK
Email: keith.abrams@le.ac.uk
(2) PATIENTS SHOULD
BE ALLOWED TO PAY FOR
STATINS
(Paying for statins)
http://bmj.com/cgi/content/full/328/7436/400
GPs should be able to offer private prescriptions
for
cholesterol lowering drugs (statins) to
patients below 3%
risk of heart disease, argue researchers
in this week's
BMJ.
Statins can help prevent coronary heart
disease in people
whose annual risk is 0.6% or more. Yet
this would lead
to treatment of over 40% of the British
adult population,
and would be unaffordable under the NHS.
Current medical practice therefore recommends
treatment only for those with a risk of
over 3% a year,
but this denies effective treatment to
32% of the adult
population.
However, if patients who are currently
ineligible for
statins were told that they could benefit
from these drugs,
some might be willing to pay for a private
prescription,
suggest GP, Nick Raithatha and health
economist,
Richard Smith.
They predict that the cost of private treatment
with
monitoring by an NHS practice nurse would
eventually
be £93.66 a year. This is far less
than average household
expenditure on, for example, alcohol (£320),
clothes
(£380) and motoring (£920),
and may therefore be quite
affordable to people on average earnings.
Although private prescriptions would increase
inequality
in access to health care, this is a form
of inequality
whereby all members of society gain and
is therefore
both economically and ethically jusifiable,
they conclude.
Contact:
Annie Ogden, Press Office, University of
East
Anglia, UK
Email: press@uea.ac.uk
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