Statins for cardiovascular prevention according to different strategies: a cost analysis.
BACKGROUND
Several studies have shown that treatment with HMG-CoA reductase inhibitors (statins) can reduce coronary heart disease (CHD) rates. However, the cost effectiveness of statin treatment in the primary prevention of CHD has not been fully established.


OBJECTIVE
To estimate the costs of CHD prevention using statins in Switzerland according to different guidelines, over a 10-year period.


METHODS
The overall 10-year costs, costs of one CHD death averted, and of 1 year without CHD were computed for the European Society of Cardiology (ESC), the International Atherosclerosis Society (IAS), and the US Adult Treatment Panel III (ATP-III) guidelines. Sensitivity analysis was performed by varying number of CHD events prevented and costs of treatment.


RESULTS
Using an inflation rate of medical costs of 3%, a single yearly consultation, a single total cholesterol measurement per year, and a generic statin, the overall 10-year costs of the ESC, IAS, and ATP-III strategies were 2.2, 3.4, and 4.1 billion Swiss francs (SwF [SwF1 = $US0.97]). In this scenario, the average cost for 1 year of life gained was SwF352, SwF421, and SwF485 thousand, respectively, and it was always higher in women than in men. In men, the average cost for 1 year of life without CHD was SwF30.7, SwF42.5, and SwF51.9 thousand for the ESC, IAS, and ATP-III strategies, respectively, and decreased with age. Statin drug costs represented between 45% and 68% of the overall preventive cost. Changing the cost of statins, inflation rates, or number of fatal and non-fatal cases of CHD averted showed ESC guidelines to be the most cost effective.


CONCLUSIONS
The cost of CHD prevention using statins depends on the guidelines used. The ESC guidelines appear to yield the lowest costs per year of life gained free of CHD.
Institute of Health Economics and Management, University of Lausanne, Lausanne, Switzerland.
Marcia K
MK
Ito
David
D
Nanchen
Nicolas
N
Rodondi
Fred
F
Paccaud
Gérard
G
Waeber
Peter
P
Vollenweider
Pedro
P
Marques-Vidal
D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000191:economics* / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D058006:General Practice; D017048:Health Care Costs; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors