Statin cost effectiveness in primary prevention: a systematic review of the recent cost-effectiveness literature in the United States

Abstract

Background: The literature on the cost-effectiveness of statin drugs in primary prevention of coronary heart disease is complex. The objective of this study is to compare the disparate results of recent cost-effectiveness analyses of statins.

Findings: We conducted a systematic review of the literature on statin cost-effectiveness. The four studies that met inclusion criteria reported varying conclusions about the cost-effectiveness of statin treatment, without a clear consensus as to whether statins are cost-effective for primary prevention. However, after accounting for each study's assumptions about statin costs, we found substantial agreement among the studies. Studies that assumed statins to be more expensive found them to be less cost-effective, and vice-versa. Furthermore, treatment of low-risk groups became cost-effective as statins became less expensive.

Conclusions: Drug price is the primary determinant of statin cost-effectiveness within a given risk group. As more statin drugs become generic, patients at low risk for coronary disease may be treated cost-effectively. Though many factors must be weighed in any medical decision, from a cost-effectiveness perspective, statins may now be considered an appropriate therapy for many patients at low risk for heart disease.

Figure 1

Article selection. Flowchart of article selection.

Figure 2

Reported ranges of cost-effectiveness ratios. Reported range of cost per QALY or LYG for the use of statins for primary prevention within each study. Also shown is the projected cost per QALY or LYG for men at average or 7.5% 10-year risk for coronary disease. Values shown are derived from the “base case” assumptions of the model used in each study, with the variable being the risk level of the patient population or the treatment strategy applied. For Prosser et al., Caro et al., and Pignone et al., these values represent ranges for men at varying risk levels. For Pletcher et al., these values represent the cost-effectiveness of statin treatment strategies as compared to a baseline of standard primary prevention guidelines. All values adjusted to 2006 dollars. QALY, quality adjusted life year; LYG, life year gained.

Figure 3

Cost-effectiveness ratios for patients at specific risk levels. Incremental cost-effectiveness ratios, shown on the y-axis, were extracted from each article and grouped by 10-year Framingham cardiac risk levels. Within each risk level, the cost-effectiveness of statin treatment was compared with the presumed annual price of statin drugs from each study. Linear regression analysis using Excel spreadsheet function is also shown. QALY, quality adjusted life year; LYG, life year gained.