Pharmaco-economic aspects of lipid-lowering therapy: is it worth the price?

The increased incidence and prevalence of coronary heart disease (CHD) in recent years has produced a great economic burden on total health care expenditure in many countries. This includes the increased cost of prevention as well as the enormous cost of treatment of CHD and related events. The clinical usefulness and benefits of statins in primary and secondary prevention of CHD has been well established. However, an important issue is whether health care decision-makers will pay for these medicines. Pharmaco-economic analyses of statins have become extremely important in substantiating the true economic value of these lipid-lowering therapies. Recently published, large-scale outcome studies demonstrate a reduction in cardiovascular morbidity and mortality with statins, and the data from these trials have been used to conduct pharmaco-economic appraisals. Statin treatment was shown to be cost-effective in comparison with other health care interventions, and cost-effectiveness was related to the efficacy of the drug and the risk of cardiovascular disease at baseline. In addition, the cost-effectiveness of statins was improved by about 40% if high density lipoprotein cholesterol levels were taken into account. It has been suggested that the cost-effectiveness of statins has been underestimated, since early large-outcome trials did not use stroke as a primary endpoint. When the costs of managing stroke were taken into consideration in recent meta-analyses, the cost-effectiveness of statins was significantly greater than had been previously thought.