title: On the hypothetical universal use of statins in primary prevention: an observational analysis on low-risk patients and economic consequences of a potential wide prescription rate.
abstract: OBJECTIVE
  Recent guidelines expand indications for statins. However, research on practical economic feasibility and cost-effectiveness in low-risk people is lacking. We aimed to describe the incidence of cardiovascular events (CVE), their total direct costs and the hypothetical effects of wide provision of statins on those rates and expenditures.
  
  
  METHODS
  We conducted a population-based cohort study using administrative data among low risk individuals. Estimators of effects of statins were taken from Cholesterol Treatment trialist metaanalysis and from Heart Protection Study trial. Two statin prices were used for analyses: National Italian Health System (€ 0.36) and the International Drug Price Indicator (€ 0.021).
  
  
  RESULTS
  Overall, 920,067 persons at low risk were identified and 14,849 CVE were registered (incidence rate 27.3 per 10,000 person-years). Direct costs for hospitalizations for CVE were 143 M €. Universal provision of statins would result in a significant decrease in CVE rates, from 27.3 to 17.5 per 10,000 person-years (PY) (95% confidence interval (CI): 15.8-19.4). Universal prescription of simvastatin 20 mg would cost 802 M €. Otherwise, provision of simvastatin at International Drug Price Indicator's prices would be both clinically effective and cost saving in men older than age 44 (observed expenditures 120 M €, expected 97.4 M €) but not in women (observed expenditures 22.7 M €, expected 36.5 M €).
  
  
  CONCLUSIONS
  Among a low-risk population, hypothetical universal provision of low-cost simvastatin to men over 44 years could be both clinically effective and a cost-saving strategy.
authors: Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy, macchia@negrisud.it.
authors: Alejandro
authors: A
authors: Macchia
authors: Javier
authors: J
authors: Mariani
authors: Marilena
authors: M
authors: Romero
authors: Fabio
authors: F
authors: Robusto
authors: Vito
authors: V
authors: Lepore
authors: Antonio
authors: A
authors: Dettorre
authors: Gianni
authors: G
authors: Tognoni
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000191:economics / Q000517:prevention & control; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D011307:Drug Prescriptions / Q000191:economics*; D004363:Drug Utilization / Q000191:economics*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000191:economics* / Q000379:methods; D019821:Simvastatin / Q000191:economics / Q000627:therapeutic use
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019821:Simvastatin