Guideline comparisons.

Lipid targets and statin initiation

ESC targets LDL 1.4 mmol/L for high risk; NZ working target is 2.0 mmol/L. PCSK9 inhibitors not funded.

Hypertension management

NZ uses absolute CVD risk threshold; ESC uses grade-based approach with additional age stratification.

Atrial fibrillation

Stroke risk thresholds broadly aligned; anticoagulant choice and access differ across jurisdictions.

Heart failure

Quadruple therapy for HFrEF is now standard. Sacubitril-valsartan funded via Special Authority; dapagliflozin funded for both HFrEF and HFpEF.

Type 2 diabetes

ADA 2024 uses a comorbidity-first framework. NZ PHARMAC restricts GLP-1 and SGLT2i to narrow special authority criteria, forcing a stepwise approach for most patients.

Gout

Treat-to-target approach is consistent. The 300 mg allopurinol ceiling myth and febuxostat access gap are the key NZ prescribing issues.

Obesity and weight management

NICE 2023 and RACGP 2024 both position GLP-1 agonists as standard care for eligible patients. NZ has no funded GLP-1 indication for obesity. The pharmacological treatment gap is the widest of any condition in this series.

Hypothyroidism

TSH target and subclinical treatment thresholds diverge across guidelines. Liothyronine (T3) combination therapy is funded in NZ via Special Authority, endocrinologist-initiated only.

Osteoporosis

GARVAN (NZ/AU preferred) and FRAX give different risk thresholds; PHARMAC Special Authority criteria do not map directly to FRAX scores. Denosumab cessation rebound is a critical safety issue unique to this drug class.

Asthma in adults

GINA 2024 ends SABA-only at every step. Budesonide/formoterol MART is funded in NZ; the biologic gap with AU is the major practical divergence.

COPD

Principles broadly aligned with GOLD. Single-inhaler triple therapy and roflumilast are not funded; NZ prescribing requires two separate devices for triple coverage.

Uncomplicated UTI

Fosfomycin and pivmecillinam recommended internationally are not available in NZ. Local trimethoprim resistance affects first-line choice.

Skin and soft tissue infections

First-line agents are broadly consistent. The key NZ divergences are impetigo topical therapy choice and the rheumatic fever imperative to treat GAS skin infections promptly in Maori and Pacific children.

Depression

NICE 2022 recommends psychological therapy before antidepressants for less severe depression. NZ has no equivalent of AU's Better Access scheme - the access gap is the defining divergence for NZ practice.

Cervical screening

NZ transitioned to HPV primary testing in September 2023. Now closely aligned with AU. Key divergences: stopping age (70 vs 74), post-treatment surveillance at 6 vs 12 months, and self-collection as an equity tool for Maori and Pacific women.