Wider Use of Statins May Make Economic Sense

But experts not sure British finding would apply in United States

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HealthDay Reporter

THURSDAY, May 12, 2005 (HealthDay News) -- It makes sense in terms of pounds and pence to widen the circle of people who are now prescribed cholesterol-lowering statin drugs, a new analysis of a large-scale British trial finds.

But the major differences between the British and American health-care systems make it difficult to say whether the same would hold true here, U.S. experts said.

In a purely economic analysis, British researchers in charge of the 20,000-member Heart Protection Study report in the May 12 online issue of The Lancet that the cost of avoiding future medical problems justifies the wider use of statins. This is especially true as the price of the drugs starts to drop as some come off patent and are available in generic form, the researchers added. They found a relative reduction of 22 percent in hospitalization costs for the group that took statins.

Overall, the study showed that the financial cost of avoiding a major vascular event was 11,600 pounds -- about $21,800 dollars at the current exchange rate -- the report said, but that cost varied widely, depending on the status of individual patients.

For example, the cost was 4,500 pounds ($8,500) for someone with a 42 percent five-year risk of having a major cardiovascular event. But it was 31,100 pounds ($58,500) for those with a 12 percent five-year risk.

A statement by trial leader Dr. Rory Collins, of the University of Oxford, noted that the price of simvastatin (Zocor) had fallen to just 15 percent of its original cost since the drug became available in generic form in May 2003. "At this price, the cost savings from reduced hospitalization during the treatment period would outweigh the cost of 40-milligram simvastatin daily for people with a five-year major vascular event risk down to at least 12 percent," he said.

But Kumiko Ikai, a health economist at the U.S. Centers for Disease Control and Prevention who wrote an accompanying editorial in the journal, was more cautious.

"At this point, it is difficult to tell whether it makes economic sense to recommend this therapy to every high-risk patient," Ikai said. "It would be helpful to have more complete information. We don't know how this would affect use of outpatient resources."

Another complication in translating the British results to America is that "the study is based on the British health-care system, and costs there are much cheaper than in the United States," Ikai added.

It is "all the more important to have more information about the effects on the U.S. health system," she said. "My guess is that the results would be very different."

Dr. Steven Nissen, a cardiologist at the Cleveland Clinic Foundation who has done a lot of work on statins, said he was uncomfortable about dealing with the issue on a purely economic level.

"We don't give these drugs because of an economic analysis," Nissen said. "We give them for a health benefit. The right way to look at this is from the point of view of risk and benefit, and we need more evidence in very low-risk populations."

Another complication is that the drugs now becoming available in generic form are the first-generation statins, which are less effective than the later-generation drugs that will remain on patent for several years, Nissen noted.

"Some patients need more powerful statins, and they still are patented items," he said.

Overall, Nissen believes that widening the use of statins would not reduce medical costs.

"We have to recognize that we are not saving money by giving statins," he said. "We are going to save patients, which is what it is all about."

More information

Current recommendations about statins are given by the American Heart Association.

SOURCES: Kumiko Ikai, health economist, U.S. Centers for Disease Control and Prevention, Atlanta; Steven Nissen, cardiologist, Cleveland Clinic Foundation, Cleveland; May 12, 2005, The Lancet online

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