title: When are statins cost-effective in cardiovascular prevention? A systematic review of sponsorship bias and conclusions in economic evaluations of statins.
abstract: BACKGROUND
  We examined sponsorship of published cost-effectiveness analyses of statin use for cardiovascular (CV) prevention, and determined whether the funding source is associated with study conclusions.
  
  
  RESULTS
  We searched PubMed/MEDLINE (up to June 2011) to identify cost-effectiveness analyses of statin use for CV prevention reporting outcomes as incremental costs per quality-adjusted life years (QALY) and/or life years gained (LYG). We examined relationships between the funding source and the study conclusions by means of tests of differences between proportions. Seventy-five studies were included. Forty-eight studies (64.0%) were industry-sponsored. Fifty-two (69.3%) articles compared statins versus non-active alternatives. Secondary CV prevention represented 42.7% of articles, followed by primary CV prevention (38.7%) and both (18.7%). Overall, industry-sponsored studies were much less likely to report unfavourable or neutral conclusions (0% versus 37.1%; p<0.001). For primary CV prevention, the proportion with unfavourable or neutral conclusions was 0% for industry-sponsored studies versus 57.9% for non-sponsored studies (p<0.001). Conversely, no statistically significant differences were identified for studies evaluating secondary CV prevention (0% versus 12.5%; p=0.222). Incremental costs per QALY/LYG estimates reported in industry-sponsored studies were generally more likely to fall below a hypothetical willingness-to-pay threshold of US $50,000.
  
  
  CONCLUSIONS
  Our systematic analysis suggests that pharmaceutical industry sponsored economic evaluations of statins have generally favored the cost-effectiveness profile of their products particularly in primary CV prevention.
authors.affiliation: Centro Superior de Investigación en Salud Pública (CSISP-FISABIO), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain. ferran_catala@hotmail.com
authors.forename: Ferrán
authors.initials: F
authors.lastname: Catalá-López
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sanfélix-Gimeno
authors.forename: Manuel
authors.initials: M
authors.lastname: Ridao
authors.forename: Salvador
authors.initials: S
authors.lastname: Peiró
mesh_terms: D015982:Bias; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000191:economics / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D055811:Journal Impact Factor; D012109:Research Support as Topic / Q000191:economics
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors