Cholesterol-lowering therapy and the Australian Pharmaceutical Benefits Scheme: a population study

Objective: The Australian Pharmaceutical Benefits Scheme (PBS) expanded the criteria for eligibility for subsidised lipid-lowering therapy (LLT) in 2006. The aim of this study was to determine the use of LLT in a representative Australian population in relation to cardiovascular disease (CVD) risk, and the effectiveness of the therapy in meeting target levels. Design: Cross-sectional biomedical study with telephone interviews, questionnaires, clinical measurements, and PBS dispensing data. Subjects: Representative population sample of 4060 urban adults aged ≥18 years attending for the biomedical examination in 2001. Results: Of the 406 who qualified for PBS-subsidised LLT at that time, only 88 (21.5%) were actually on LLT. National Heart Foundation of Australia (NHF) recommended low-density lipoprotein cholesterol (LDL-C) levels of <2.5 mmol/L were recorded in only 13% (528) of the population, and in 46.8% of those on LLT. Of those on LLT, 76% had total cholesterol <5.5 mmol/L, but over 80% had total cholesterol levels above NHF-recommended levels of 4.0 mmol/L. Of the 842 classified at the highest CVD risk, only 26% were using LLT. Those aged >60 years and on low incomes were significantly more likely to use LLT. The new PBS criteria will expand eligibility to include nearly 20% of adults. Conclusions: The majority of people at high risk of CVD were not receiving LLT, and LLT is not being used to its full effectiveness. People with low incomes or on government benefits or pensions were not less likely to use LLT than others under the PBS scheme. Whether higher copayments for those on low incomes who do not qualify for concessional payments is a significant barrier to LLT use needs further research.