Cost Effectiveness of Simvastatin

The National Cholesterol Education Program has recognized that the level of LDL cholesterol below 100 mg/dL is the optimal in patients who are suffering from cardiovascular problems. Despite the fact that many important secondary prevention tests happen to have been released, two of the most helpful for the assessment of economic impact are CARE and 4S. The 4S trial was randomized among 4,444 female and male patients with the age range of 35 to 60 years with past prior Ml or angina and total cholesterol amounts of 210 to 310 mg/dl. The patients were given varied-dose of simvastatin or placebo. Nearly all patients were given at least 20 mg of simvastatin, 37% of them 40 mg/day. Simvastatin reduced total cholesterol by 25%. The research also gave a 37% reduction in the requirement for revascularization in that trial with simvastatin. In the subsequent analysis carried out, the 4S investigators discovered and reported that simvastatin therapy was effective in helping to reduce hospitalizations for serious heart disease, including revascularization (81% of them were CABG processes). During the research, total hospital days caused by heart disease were reduced by 5,138 days with the use of simvastatin. The primary statistics were based on 10 months of therapy and later have proven themselves after 22 months.

4S researchers concluded that the decrease in hospitalizations would amount to $3,872 in average cost incurred on every patient that was prescribed simvastatin. Considering the wholesale price for simvastatin during the trial carried out, averaging about $4,400 on each patient ($4,879 undiscounted), the net cost of simvastatin therapy was believed to be about $528 per patient during that trial. The cost of laboratory measurement that would be saved for those using the medication amounted to S250 per patient or an additional $0.13 daily. The entire treatment cost when simvastatin was used was $778 per patient over an average of 1,915 days (which is roughly $148 each year). As a summary, the advantage of using simvastatin was obvious within the first 10 months of the treatment and the followup treatment cost after the 10 month period continued to drop.

One interesting thing is that three separate analyses for cost-effectiveness were carried out while using data in the 4S trial. All of them proved the cost effectiveness of using the medication.

The most recently released analysis from 4S using the Markov model to judge the therapy’s cost effectiveness for various subgroups were based on four hospitals located in Sweden. Swedish costs were converted to U.S. dollars. The ability for the patients to work % their productivity due to using the medications were accounted in the research. The analysis estimated that for men who were 59 years old, the cost effectiveness of a 5-year simvastatin therapy was $7,000 ($1.600 of which accounted for working time savings) per year in savings, whereas the corresponding figure for women who were 59 years old was $15,600 ($5.100 of which accounted for working time savings). The research demonstrated the cost attractiveness of statin.

The CARE study examined pravastatin in 4,159 patients who had a total cholesterol level of under 240 mg/dl and LDL cholesterol level of 115 to 174 mg/dl.  Much like other statin tests, pravastatin lowered LDL cholesterol 28% and total cholesterol by 20% . Nonfatal MI and death were reduced by 24%. The average cost for about 6 years of pravastatin therapy under CARE was about $5,500, which was partly offset with a $1,660 savings through reduced cardiac procedures and events. CARE data calculated that 1-year with pravastatin therapy is likely to cost about S 16,000 to S31,000.

Generic simvastatin pricing made statin therapy very appealing in many risk groups as far as cost-effectiveness goes, and for that reason economically dominant.