Full treatment of the costs and benefits is needed

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7065.1143 (Published 02 November 1996) Cite this as: BMJ 1996;313:1143
  1. A S Wierzbicki,
  2. T M Reynolds
  1. Senior lecturer in chemical pathology St Thomas's Hospital, London SE1 7EH
  2. Consultant chemical pathologist Burton Hospitals, Burton on Trent, Staffordshire DE13 0RB

    EDITOR,—P D P Pharoah and W Hollingworth have produced an interesting article that is of little benefit to the debate on the health economics of lowering lipid concentrations.1 The life table approach suffers from the same deficiency as we2 have pointed out for the Sheffield risk factor table.3 Megnien et al have shown that the risk table does not differ significantly from the currently accepted guidelines once correct assumptions are made.4

    The major deficiency in the life table approach is simple—death is cheap for the health service. The principal saving for lipid lowering agents is in procedures not needed and hospital beds not required. A full cost analysis has already been published for the Scandinavian simvastatin survival study for the United States and shows reductions in cardiovascular procedures of 31% and hospital stays of 34%.5 This leads to a net cost of the drug of 28 cents (19p) a day. The data for primary prevention in men in the west of Scotland coronary prevention study would imply a cost of treble that for secondary prevention on the basis of the number of events.6 The cost analysis for secondary prevention for the United Kingdom seems to imply a cost per life year saved of £3000-6000, depending on the assumptions made, not £361 000 for secondary prevention.7 This is based on reducing 86 cardiovascular deaths to 23, 679 hospital days to 231, and 19 angioplasties to six—that is, £237 000 reduced to £73 800 per 100 patients treated.7

    It is difficult to find other treatments that have been as thoroughly evaluated as lowering lipid concentrations in terms of cost-return analysis. For secondary prevention the data are as good as those for severe hypertension (diastolic pressure >110 mm Hg), and for primary prevention they are similar to those for treating moderate hypertension. Unless cost analyses are conducted in full and include the cost of procedures, visits to outpatient departments and general practitioners, and stays in hospital any data that arise are highly misleading and not useful in health economic terms.


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