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Meta-Analysis
. 2013 Jul 8;8(7):e69462.
doi: 10.1371/journal.pone.0069462. Print 2013.

When are statins cost-effective in cardiovascular prevention? A systematic review of sponsorship bias and conclusions in economic evaluations of statins

Ferrán Catalá-López  1 , Gabriel Sanfélix-Gimeno, Manuel Ridao, Salvador Peiró
Affiliations
Meta-Analysis

When are statins cost-effective in cardiovascular prevention? A systematic review of sponsorship bias and conclusions in economic evaluations of statins

Ferrán Catalá-López et al. PLoS One. .

Abstract

Background: We examined sponsorship of published cost-effectiveness analyses of statin use for cardiovascular (CV) prevention, and determined whether the funding source is associated with study conclusions.

Methods and findings: We searched PubMed/MEDLINE (up to June 2011) to identify cost-effectiveness analyses of statin use for CV prevention reporting outcomes as incremental costs per quality-adjusted life years (QALY) and/or life years gained (LYG). We examined relationships between the funding source and the study conclusions by means of tests of differences between proportions. Seventy-five studies were included. Forty-eight studies (64.0%) were industry-sponsored. Fifty-two (69.3%) articles compared statins versus non-active alternatives. Secondary CV prevention represented 42.7% of articles, followed by primary CV prevention (38.7%) and both (18.7%). Overall, industry-sponsored studies were much less likely to report unfavourable or neutral conclusions (0% versus 37.1%; p<0.001). For primary CV prevention, the proportion with unfavourable or neutral conclusions was 0% for industry-sponsored studies versus 57.9% for non-sponsored studies (p<0.001). Conversely, no statistically significant differences were identified for studies evaluating secondary CV prevention (0% versus 12.5%; p=0.222). Incremental costs per QALY/LYG estimates reported in industry-sponsored studies were generally more likely to fall below a hypothetical willingness-to-pay threshold of US $50,000.

Conclusions: Our systematic analysis suggests that pharmaceutical industry sponsored economic evaluations of statins have generally favored the cost-effectiveness profile of their products particularly in primary CV prevention.

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Conflict of interest statement

Competing Interests: SP is president of the Fundación Instituto de Investigación en Servicios de Salud, a non-profit organization promoting health services research that has received funding from both public and private third parties, including a non-conditioned funding/grant from Novartis for activities for research diffusion. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Flow diagram of study selection
process.
Figure 2
Figure 2. Variations in cost-effectiveness results by funding source and prevention category: a) Primary CV prevention and b) Secondary CV prevention.
CV: Cardiovascular. Note: Each dot represents an incremental cost (in US$) per QALY/LYG in the reviewed articles. The horizontal line represents the willingness-to-pay threshold.
See this image and copyright information in PMC

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