Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

Comparative Effectiveness of Hydroxymethyl-glutaryl-coenzyme A-reductase (HMG CoA) Inhibitors

in the Prevention of Neurodegenerative Disease, Septicemia, and Ventilator-associated Pneumonia

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

In the case of septicemia and ventilator associated pneumonia, Hydroxymethyl-glutaryl-coenzyme A-reductase Inhibitors versus not receiving this class of drugs.

For neurodegenerative diseases, the neuroprotective activity of HMG CoA can be determined by prescription symmetry analysis using administrative data. In this approach, patients are screened for prescriptions for drugs of interest (i.e., statins) and for other drugs that are markers for the disease in question, e.g., cholinesterase inhibitors (donepezil, galantamine, rivastigmine, or tacrine) or memantine for Alzheimer’s or levodopa, pramipexole, or selegiline for Parkinson’s. Then the records of patients who over time have received prescriptions for both drugs are checked to see which drug was prescribed first. The null hypothesis is that as many patients have had statins prescribed before donepezil or levodopa as have these drugs prescribed in the reverse temporal sequence. If statins do protect against Alzheimer’s or Parkinson’s, then a significant excess of patients who received both types of prescriptions may have received the cholesterol-lowering agent after the central-nervous-system agent. Furthermore, if individual statins vary in their neuroprotective effectiveness, then the temporal asymmetry may be most pronounced with respect to those same statins. Here allowances may be needed for variation in when the drugs entered the market and in individual formulary preferences and inducements.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

patient age, race, and sex and other potential confounders may be desirable.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Mortality/pt survival/disease severity

Describe any health-related risks, side effects, or harms that you are concerned about.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Dementia, including Alzheimer's disease
• Infectious diseases, including HIV/AIDS

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Children
• Elderly
• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

• Medicaid
• Medicare
• State Children's Health Insurance Program (SCHIP)

Importance

Describe why this topic is important.

Recent attention has focused on the possibility that statins may protect against neurodegenerative diseases including Alzheimer-type dementia and Parkinson’s disease (4), although not all studies have supported this hypothesis. A second area of interest is the possibility that statins may have a therapeutic application in septicemia, but here, again, the evidence is mixed .

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Potential Impact

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Describe the timeframe in which an answer to your question is needed.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Nominator Information

Other Information About You: (optional)

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Are you making a suggestion as an individual or on behalf of an organization?

no answer

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