135 mg/dL; 75%
male). Subjects were stratified into quintiles based on their
pretreatment 5-year risk for vascular events (median, 42% in the
highest quintile, 12% in the lowest).In the randomized, placebo-controlled U.K. Heart Protection
Study, simvastatin therapy (40 mg daily) reduced the rates of myocardial
infarction, stroke, and revascularization in a wide range of
high-risk individuals (Journal Watch Jul 30 2002). Now investigators
have conducted a cost-effectiveness analysis of simvastatin therapy
among the 20,000 trial participants, all of whom had vascular disease
or diabetes (age range, 40–80; minimum total cholesterol level,
135 mg/dL; 75%
male). Subjects were stratified into quintiles based on their
pretreatment 5-year risk for vascular events (median, 42% in the
highest quintile, 12% in the lowest).
Hospitalization costs for vascular events were significantly lower with simvastatin than with placebo. The relative reduction was about 22%, regardless of age, sex, baseline LDL cholesterol level, prior vascular disease, or risk quintile. The absolute cost of statin treatment was similar in all subgroups. Based on 2001 drug prices, 57% of the cost of statin use in the highest quintile — and 18% in the lowest quintile — was offset by reduced hospitalization costs. Assuming that simvastatin prices are now 75% lower in the U.K. because of patent expiration, statin treatment should generate net cost savings in the top four quintiles (i.e., those with 5-year vascular risk >18%).
The results of this study, partly funded by industry, suggest that statins might be both clinically beneficial and cost-effective in a wider range of patients than generally are treated under current guidelines.
Reference:
Heart Protection Study Collaborative Group. Cost-effectiveness of simvastatin in people at different levels of vascular disease risk: Economic analysis of a randomized trial in 20 536 individuals. Lancet 2005 May 21; 365:1779-85.