Cost effectiveness of cholesterol-lowering drugs: a review of the evidence

Four studies of the cost per life year saved through lipid lowering with lovastatin or simvastatin showed considerable variation in the results. For example, the cost per life year saved on administration of simvastatin 20 mg/day for primary prevention in men 42 years old at the start of therapy and with an initial cholesterol level of 8 mmol/L, was 19,000 1994-US dollars according to one study, and 55,000 according to another. Both when the differences were due to different cost estimates and when they were due to different estimates of the number of life years saved, plausible explanations for the discrepancies between the cost-effectiveness ratios were generally found. The cost per life year saved through primary prevention was about three times greater among women than men at age 40, twice greater at age 60, an 1.3 times greater at age 70. The accordance between the studies was not good regarding how cost per life year saved varies with age at the start of drug therapy. According to one study, the cost per life year saved for secondary prevention is generally low. We also compared the estimates for statins with estimates for several other life-extending health interventions. Given current guidelines for the prescription of cholesterol-lowering drugs, primary prevention with statins seems generally to be one of the less cost-effective life extending health interventions, especially for women. The cost effectiveness of statins is likely to become more favorable, though, when the patients on these drugs expire.