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BMJ No 7122 Volume 315 Letters Saturday 13 December 1997 Use of statins See Editorial by Muldoon p1554 Trent institute's research working group has produced guidance for purchasers Editor Freemantle et al's editorial on statins makes important points about the desirability of linking the benefits of new treatments to their costs to allow sensible decisions on health purchasing.(1) Nevertheless, the attack on the Standing Medical Advisory Committee's guidance seems harsh. The quality of evidence on the effectiveness of statins, and its use by the committee, makes for guidance that is better than that for nearly every other treatment one can imagine. It is not unreasonable for the committee to leave the costing work to others. The authors of the editorial also ignore the fact that others have addressed the issues that they raise and that further work is being undertaken. Trent Institute for Health Services' research working group on acute purchasing, which I chair, produces a series of guidance reports for purchasers, and one relates to statins.(2) That report sets out the gross and net impacts on costs for a typical district; sets out the likely impact on other services for a typical district; estimates life years likely to be gained at different levels of intervention (and therefore costs); and compares costs per life year gained with statin treatment with those for activities already undertaken in the NHS. Trent regional executive has commissioned further work from the School of Health and Related Research at the University of Sheffield to develop a computer model ('statins toolkit'). This will allow health authorities to examine the consequences for health outcomes and resource use for their locality of four options: not using statins; using them in secondary prevention (in terms of myocardial infarctions and other events prevented); using them in primary prevention (at a 4.5%, 3%, and 1.5% annual risk of a coronary event); and phasing in their use over years. The main issue highlighted by the editorial is the need to coordinate effectively the guidance emanating from a variety of sources so that harassed purchasers know where to locate the best advice. R L Akehurst Professor of health economics School of Health and Related Research, University of Sheffield, Sheffield S1 4DA References 1 Freemantle N, Barbour R, Johnson R, Marchment M, Kennedy A. The use of statins: a case of misleading priorities? BMJ 1997;315:826-8. (4 October.) 2 Working Group on Acute Purchasing. Statin therapy/HMG coA reductase inhibitor treatment in the prevention of coronary heart disease. Sheffield: Trent Institute for Health Services Research Working Group on Acute Purchasing, University of Sheffield, 1996. (Guidance note for purchasers 96/04.) Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline