Therapeutic interchange: an effective strategy for statin cost containment at a Saudi medical centre

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To evaluate the impact of therapeutic interchange on the pharmacy budget at Saudi Aramco Medical Services Organization (SAMSO).


In 2006, Pharmacy Services Division (PSD) evaluated the top 50 medications by expense and identified the 3-hydroxy-3-methylglutaryl CoA reductase inhibitors (statins) class of medications as the top drug class, by expense, for SAMSO. The three available medications at SAMSO from this class were atorvastatin, simvastatin and pravastatin. Atorvastatin was the number one drug, by expense, for the pharmacy budget. The cost of atorvastatin was approximately 10 times that of simvastatin, in addition, there is strong literature support for therapeutic interchange of atorvastatin with simvastatin. An internal analytical tool called Therapeutic Interchange Management Program (TIMP) was developed and utilized. TIMP utilizes a five step process: a preliminary proposal with literature support, collaboration with key stakeholders, obtain approval from appropriate authorities, design a process to facilitate implementation, and education of all involved.

Key findings

Approximately 50% of patients have been switched from atorvastatin to simvastatin resulting in a cost savings of approximately US$500 000 over a one year period for SAMSO.


Targeted therapeutic interchange is an effective strategy to help curb the rising cost of pharmaceuticals in a hospital setting. TIMP is a useful tool for implementation of therapeutic interchange in a hospital environment.

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