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Original Articles

Statin Cost-Effectiveness in the United States for People at Different Vascular Risk Levels

Heart Protection Study Collaborative Group

MRC/BHF Heart Protection Study Collaborative Group committees, collaborators, and participating hospitals are listed in the online appendix.

Correspondence to Heart Protection Study, Clinical Trial Service Unit and Epidemiological Studies Unit, Richard Doll Building, Old Road Campus, Headington, Oxford OX3 7LF, United Kingdom. E-mail hps{at}ctsu.ox.ac.uk

Received July 18, 2008; accepted December 1, 2008.

Background— Statins reduce the rates of heart attacks, strokes, and revascularization procedures (ie, major vascular events) in a wide range of circumstances. Randomized controlled trial data from 20 536 adults have been used to estimate the cost-effectiveness of prescribing statin therapy in the United States for people at different levels of vascular disease risk and to explore whether wider use of generic statins beyond the populations currently recommended for treatment in clinical guidelines is indicated.

Methods and Results— Randomized controlled trial data, an internally validated vascular disease model, and US costs of statin therapy and other medical care were used to project lifetime risks of vascular events and evaluate the cost-effectiveness of 40 mg simvastatin daily. For an average of 5 years, allocation to simvastatin reduced the estimated US costs of hospitalizations for vascular events by 20% (95% CI, 15 to 24) in the different subcategories of participants studied. At a daily cost of $1 for 40 mg generic simvastatin, the estimated costs of preventing a vascular death within the 5-year study period ranged from a net saving of $1300 (95% CI, $15 600 saving to $13 200 cost) among participants with a 42% 5-year major vascular event risk to a net cost of $216 500 ($123 700 to $460 000 cost) among those with a 12% 5-year risk. The costs per life year gained with lifetime simvastatin treatment ranged from $2500 (–$40 to $3820) in people aged 40 to 49 years with a 42% 5-year major vascular event risk to $10 990 ($9430 to $14 700) in people aged 70 years and older with a 12% 5-year risk.

Conclusions— Treatment with generic simvastatin appears to be cost-effective for a much wider population in the United States than that recommended by current guidelines.

Key Words: cost-benefit analysis • cardiovascular diseases • statin intervention

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CLINICAL PERSPECTIVE

The online Data Supplement is available at http://circoutcomes.ahajournals.org/cgi/content/full/OUTCOMES.108.808469/DC1.

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Statin Cost-Effectiveness in the United States for People at Different Vascular Risk Levels

Heart Protection Study Collaborative Group
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