A report in the British Medical Journal says that England's NHS could save in excess of £2 billion over a five year period if prescriptions were switched to generic statins.

(Statins are cholesterol-lowering drugs)

Report authors, James Moon and Richard Bogle, both senior doctors, say statin prescriptions have gone up by 30% every year in England for several years - they cost the NHS £738 million in 2004. Statins now represent the largest part of the NHS drug bill.

40% of all statin prescriptions are for atorvastatin, followed by simvastatin. 85% of prescriptions are for 10 and 20 mg atorvastatin doses, the lower doses. Simvastatin is much cheaper than atorvastatin as its patent expired. Atorvastatin's patent expires in 2011.

By switching from the lower dose atorvastatin prescription to the cheaper statin the NHS would save £1 billion (pounds sterling) over the next five years. Another £1 billion will be saved anyway because of the fall in price of simvastatin.

Following the new NICE guidelines which recommend that 14% of adults should receive statins, the number of prescriptions are set to rise dramatically. The rise could mean an additional cost of £250 million per year for, but just £75 million if all prescriptions were switched to generics.

The report states that both statins are equally safe and effective, according to several large independent studies. Where is the justification, say the authors, in continuing to prescribe both if the only difference between them is cost?

University College London Hospitals NHS Foundation Trust is switching to simvastatin as its first line statin - a move which should save the trust about £80,000 per year. Three other London primary care trusts are also going to do the same. If these moves were replicated nationally the economic benefits for England's National Health Service would be enormous, says the report.

The authors say "It is time for the United Kingdom to implement therapeutic substitution of simvastatin nationally by switching patients currently taking lower doses of atorvastatin, and prescribing generic simvastatin 40mg for new patients needing primary prevention of coronary heart disease. This policy would save £2bn, increase value for money, and release much needed resources to other areas of the NHS."

Click here to view the report (PDF)