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BMJ No 7122 Volume 315 Letters Saturday 13 December 1997 Use of statins See Editorial by Muldoon p1554 Faculty's advice does refer to cost effictiveness Editor In their editorial on the Standing Medical Advisory Committee's guidance on the use of statins,(1,2) Freemantle et al also criticise recent advice from the Faculty of Public Health Medicine addressed to local directors of public health.(3) Unfortunately, they do not seem to have read the faculty's advice very carefully. While they correctly state that the faculty advocates locally developed guidelines that target high risk patients and consider issues of cost effectiveness, they then go on to contradict themselves by saying that the faculty's advice makes no reference to cost effectiveness. In fact, the faculty's advice deals extensively with costs as well as effectiveness and clearly states that local policies should take account of the resources available. The faculty recognises that the resources that each purchaser wishes to allocate to pharmacological lipid lowering 'will depend on local priorities within coronary heart disease prevention, cardiology and total health care expenditure' and that this decision 'should be taken by consensus among the stakeholders.' Cost effectiveness studies on the use of statins in practice are currently limited, and none so far has included such crucial aspects as prescribers' compliance with local policy, patients' compliance with treatment, or the cost and effectiveness of newer statins. While the faculty agrees with Freemantle et al in their assertion that more evidence on the cost effectiveness of statins is needed, we believe firmly that enough is already known to allow local decision makers to issue policies on lipid lowering based on absolute risk. In view of the rapidly escalating costs of widespread inappropriate and ineffective prescribing of statins, this task is urgent and cannot wait until all the evidence is in. Alan Maryon Davis Convener, cardiovascular working group Faculty of Public Health Medicine, 4 St Andrews Place, London NW1 4LB References 1 Standing Medical Advisory Committee. The use of statins. London: Department of Health, 1997. (11061 HCD August 97(04).) 2 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.) 3 Faculty of Public Health Medicine. Lipid lowering-how to draw the line. Guidance for directors of public health. London: FPHM, 1997. Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline