Statin cost effectiveness in primary prevention: A systematic review of the recent cost-effectiveness literature in the United States

BMC Research Notes

Ross J Simpson²  Aaron P Mitchell¹ 

[1] Duke University Medical Center, Medical Residency Office Rm 8254DN, 2301 Erwin Rd, Durham, NC, 27710, USA;Department of Cardiology, UNC-Chapel Hill School of Medicine, 101 Manning Drive, Chapel Hill, NC, 27514, USA

关键词: Systematic review;    Drug cost;    Primary prevention;    Cost-effectiveness;    Statin;   

Others  :  1166096
DOI  :  10.1186/1756-0500-5-373

 received in 2012-02-01, accepted in 2012-07-03,  发布年份 2012

【 摘 要 】

Background

The literature on the cost-effectiveness of statin drugs in primary prevention of coronary heart disease is complex. The objective of this study is to compare the disparate results of recent cost-effectiveness analyses of statins.

Findings

We conducted a systematic review of the literature on statin cost-effectiveness. The four studies that met inclusion criteria reported varying conclusions about the cost-effectiveness of statin treatment, without a clear consensus as to whether statins are cost-effective for primary prevention. However, after accounting for each study’s assumptions about statin costs, we found substantial agreement among the studies. Studies that assumed statins to be more expensive found them to be less cost-effective, and vice-versa. Furthermore, treatment of low-risk groups became cost-effective as statins became less expensive.

Conclusions

Drug price is the primary determinant of statin cost-effectiveness within a given risk group. As more statin drugs become generic, patients at low risk for coronary disease may be treated cost-effectively. Though many factors must be weighed in any medical decision, from a cost-effectiveness perspective, statins may now be considered an appropriate therapy for many patients at low risk for heart disease.

【 授权许可】

   
2012 Mitchell and Simpson; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]LaRosa JC, He J, Vupputuri S: Effect of statins on risk of coronary disease: a meta-analysis of randomized controlled trials. JAMA 1999, 282(24):2340-2346.
• [2]Brugts JJ, Deckers JW: Statin prescription in men and women at cardiovascular risk: to whom and when? Curr Opin Cardiol 2010, 25(5):484-489.
• [3]Brugts JJ, Yetgin T, Hoeks SE, et al.: The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials. BMJ 2009, 338:b2376.
• [4]Amarenco P, Labreuche J: Lipid management in the prevention of stroke: review and updated meta-analysis of statins for stroke prevention. Lancet Neurol 2009, 8(5):453-463.
• [5]Ray KK, Seshasai SRK, Erqou S, et al.: Statins and all-cause mortality in high-risk primary prevention: a meta-analysis of 11 randomized controlled trials involving 65,229 participants. Arch Intern Med 2010, 170(12):1024-1031.
• [6]Knopp RH: Drug treatment of lipid disorders. N Engl J Med 1999, 341(7):498-511.
• [7]Mihaylova B, Briggs A, Armitage J, et al.: Cost-effectiveness of simvastatin in people at different levels of vascular disease risk: economic analysis of a randomised trial in 20,536 individuals. Lancet 2005, 365(9473):1779-1785.
• [8]Shepherd J, Cobbe SM, Ford I, et al.: Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med 1995, 333(20):1301-1307.
• [9]Franco OH, Peeters A, Looman CWN, Bonneux L: Cost effectiveness of statins in coronary heart disease. J Epidemiol Community Health 2005, 59(11):927-933.
• [10]Ward S, Lloyd Jones M, Pandor A, et al.: A systematic review and economic evaluation of statins for the prevention of coronary events. Health Technol Assess 2007, 11(14):1-160. iii–iv
• [11]Morrison A, Glassberg H: Determinants of the cost-effectiveness of statins. J Manag Care Pharm 2003, 9(6):544-551.
• [12]Pletcher MJ, Lazar L, Bibbins-Domingo K, et al.: Comparing impact and cost-effectiveness of primary prevention strategies for lipid-lowering. Ann Intern Med 2009, 150(4):243-254.
• [13]Caro J, Huybrechts KF, Klittich WS, Jackson JD, McGuire A: Allocating funds for cardiovascular disease prevention in light of the NCEP ATP III guidelines. Am J Manag Care 2003, 9(7):477-489.
• [14]Prosser LA, Stinnett AA, Goldman PA, et al.: Cost-effectiveness of cholesterol-lowering therapies according to selected patient characteristics. Ann Intern Med 2000, 132(10):769-779.
• [15]Pignone M, Earnshaw S, Tice JA, Pletcher MJ: Aspirin, statins, or both drugs for the primary prevention of coronary heart disease events in men: a cost-utility analysis. Ann Intern Med 2006, 144(5):326-336.
• [16]Evans C, Tavakoli M, Crawford B: Use of quality adjusted life years and life years gained as benchmarks in economic evaluations: a critical appraisal. Health Care Manag Sci 2004, 7(1):43-49.
• [17]Curtiss FR, Fairman KA: Tough questions about the value of statin therapy for primary prevention: did JUPITER miss the moon? J Manag Care Pharm 2010, 16(6):417-423.
• [18]Findlay S: The statin drugs: prescription and price trends, October 2005 to December 2006. Consumers Union, ; 2007. Available at: www.consumerreports.org/health/resources/pdf/best-buy-drugs/Statins-RxTrend-FINAL-Feb2007.pdf webcite
• [19]Wilson PW, D’Agostino RB, Levy D, et al.: Prediction of coronary heart disease using risk factor categories. Circulation 1998, 97(18):1837-1847.
• [20]Grover SA, Ho V, Lavoie F, et al.: The importance of indirect costs in primary cardiovascular disease prevention: can we save lives and money with statins? Arch Intern Med 2003, 163(3):333-339.
• [21]Taylor F, Ward K, Moore TH, et al.: Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev 2011, 1:CD004816.
• [22]Greving JP, Visseren FLJ, de Wit GA, Algra A: Statin treatment for primary prevention of vascular disease: whom to treat? Cost-effectiveness analysis. BMJ 2011, 342:d1672.