Statins Remain Cost Effective, Not Cost Saving

Today’s Managing Health Care Costs Indicator is $169,549

Click on image to enlarge.  Source below

Statins are enormously effective drugs that, along with a decrease in cigarette smoking, have been responsible for a huge decrease in the incidence of cardiac death, especially in young men.    Statins were shown to be effective  at lowering mortality in 1994  in the 4S study (Scandinavian Simvastatin Survival Study).   This study was reevaluated in 1996 to look at changes in hospital costs, and the saved hospitalizations in the treatment group covered 88% of the cost of simvastatin in the high risk group.  

Simvastatin has been a generic medication for a few years, and atorvastatin (Lipitor) is going generic this coming month. Have we finally reached a point where the use of statins is not merely cost-effective, but is actually cost-saving?

Even with dramatic declines in the acquisition cost of the statin medications, though, treatment in this simulation done in BMJ this past March was not cost-saving in any cohort.  The cost of a Quality Adjusted Life Year for a 55 year old man with a 5% ten year risk of a heart attack was 125,544 euros (or  almost $170K)

As you can see from the graphic – the cost to save lives with simvastatin was actually quite modest in many instances - especially over the longer time horizons. For instance, it cost only 5394 Euros for each QALY for 55 year old men at a 30% risk for a vascular event over the following 10 years. Still, not a single simulated group gained QALYs with LOWER costs. 

We don’t save money by using even generic statins for primary prevention of heart of vascular disease.   We only gain good health outcomes for a reasonable cost -- which doesn’t seem to me to be a bad outcome at all.