The CASE for fire and forget

doi:10.1136/bmj.39493.452650.1F

BMJ 2008;336:406 (23 February), doi:10.1136/bmj.39493.452650.1F

Letters

Strategies for statins

The CASE for fire and forget

The first 150 words of the full text of this article appear below.

I write with reference to the editorial by Donner-Banzhoff andSönnichsen.¹ Four factors make the CASE for Shepherd’soriginal proposal to move the prescription of statin on to thesame footing that aspirin now occupies.²

Cost—A diminishing returns dose-response curve exists,whereby the initial 10 mg of simvastatin produces 75% of themaximum response, and each dose increment produces a reducingincremental gain, at increasing cost per unit gain. For example,since 10 mg of atorvastatin produces half the cholesterol loweringachieved by 80 mg atorvastatin, and drugpricing is effectivelylinear, then offering eight people 10 mg of atorvastatin isfour times as effective as offering one person 80 mg. Atorvastatinis 20 times more costly than simvastatin, but only twice aspotent, dose for dose

Acceptability—Avoidance of unnecessaryrepeated cholesteroltests and clinic visits is welcomed bypatients, doctors, andhealth accountants

Safety—Therisk of side . . . [Full text of this article]

L Sam Lewis, general practitioner

¹ Surgery, Newport, Pembrokeshire SA42 0TJ

sam@garthnewydd.freeserve.co.uk