BMJ  2006;333:1145 (2 December), doi:10.1136/bmj.38993.731725.BE (published 10 November 2006)

Research

Lifetime cost effectiveness of simvastatin in a range of risk groups and age groups derived from a randomised trial of 20 536 people

Objectives To evaluate the cost effectiveness of 40 mg simvastatin daily continued for life in people of different ages with differing risks of vascular disease.

Design A model developed from a randomised trial was used to estimate lifetime risks of vascular events and costs of treatment and hospital admissions in the United Kingdom.

Setting 69 hospitals in the UK.

Participants 20 536 men and women (aged 40-80) with coronary disease, other occlusive arterial disease, or diabetes.

Interventions 40 mg simvastatin daily versus placebo for an average of 5 years.

Main outcome measures Cost effectiveness of 40 mg simvastatin daily expressed as additional cost per life year gained. Major vascular event defined as non-fatal myocardial infarction or death from coronary disease, any stroke, or revascularisation procedure. Results were extrapolated to younger and older age groups at lower risk of vascular disease than were studied directly, as well as to lifetime treatment.

Results At the April 2005 UK price of £4.87 (7; $9) per 28 day pack of generic 40 mg simvastatin, lifetime treatment was cost saving in most age groups and vascular disease risk groups studied directly. Gains in life expectancy and cost savings decreased with increasing age and with decreasing risk of vascular disease. People aged 40-49 with 5 year risks of major vascular events of 42% and 12% at start of treatment gained 2.49 and 1.67 life years, respectively. Treatment with statins remained cost saving or cost less than £2500 per life year gained in people as young as 35 years or as old as 85 with 5 year risks of a major vascular event as low as 5% at the start of treatment.

Conclusions Treatment with statins is cost effective in a wider population than is routinely treated at present.

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Rapid Responses:

Read all Rapid Responses

300 years of tablet taking

Richard G Richards
bmj.com, 22 Nov 2006 [Full text]

What is the most cost-effective dose of Simvastatin ?

Leslie S Lewis
bmj.com, 2 Dec 2006 [Full text]

Common miracles

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Flawed study?

Jeffrey R johnstone
bmj.com, 3 Dec 2006 [Full text]

Conclusion misleading

john sharvill
bmj.com, 4 Dec 2006 [Full text]

Re: Conclusion misleading

L S Lewis
bmj.com, 6 Dec 2006 [Full text]

Competing interests

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Simvastatin Even Cheaper And More Cost Effective Than Suggested

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Marginal vs average costs

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bmj.com, 9 Dec 2006 [Full text]

Re: Marginal vs average costs

L S Lewis
bmj.com, 11 Dec 2006 [Full text]

The evidence mounts further yet we are still failing to provide basic care to those who need it most

Beck Taylor, et al.
bmj.com, 19 Dec 2006 [Full text]

Re: The evidence mounts further yet we are still failing to provide basic care to those who need it most

L S Lewis
bmj.com, 20 Dec 2006 [Full text]

Agreement between PH and GPs?

Richard G Richards
bmj.com, 21 Dec 2006 [Full text]

We must get the basics right

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bmj.com, 22 Dec 2006 [Full text]