More people could benefit from statins

10 November 2006

Statin treatment should be considered in a wider range of people than is currently recommended in the UK, results of a cost-effectiveness analysis indicate.

"At current generic prices, the initiation of lifetime treatment with simvastatin is cost-saving or very cost effective for people aged 35-85 with risk of major vascular events as low as 1% per annum," the authors report in a British Medical Journal article published early online.

This means that people with a risk half of the threshold currently proposed by the National Institute for Health and Clinical Excellence (NICE) stand to benefit from statin treatment, they add.

To extend on previous cost-effectiveness studies of statin use, investigators from the Heart Protection Study Collaborative Group developed and validated a model to allow extrapolation beyond the 5-year treatment period of the Heart Protection Study (HPS), and estimation of lifetime cost per life year gained and per quality adjusted life year gained. These estimates were then projected beyond the levels of risk of vascular diseases and age that were represented in the HPS.

HPS included over 20,000 participants, aged between 40 and 80 years, with total cholesterol levels of at least 3.5 mmol/l and a history of coronary disease, cerebrovascular disease, other occlusive arterial disease, diabetes, or (if a man aged 65 years or more) hypertension. These patients were randomly assigned to 40 mg/day simvastatin or placebo.

The investigators report that gains in life expectancy and cost savings decreased with increasing age and with decreasing risk of vascular disease. People aged 40-49 years with a 5-year major vascular event risk of 42% and 12% at start of treatment gained 2.49 and 1.67 life-years, respectively.

The treatment remained cost saving in people aged 35 years to 85 years with 5-year risks of a major vascular event as low as 5% at the start of treatment.

Thus, the reduced costs of hospital admissions due to fewer events outweighed the increased costs of statin treatments in almost all risk/age categories studied.

"Statin therapy should be considered routinely for people across a wider range and at a lower risk for vascular disease than is currently the case," the authors conclude.

Br Med J 2006; Advance online publication