UK review finds statins are cost effective in secondary prevention

BMJ 1999; 319 doi: (Published 27 November 1999) Cite this as: BMJ 1999;319:1390
  1. Zosia Kmietowicz
  1. London

    Statins are most cost effective when used in patients with evidence of cardiovascular disease, in whom they reduce mortality as well as morbidity, according to a review by an advisory body to the NHS, the Health Technology Assessment.

    The review is the 53rd in a series produced by the Health Technology Assessment designed to provide the NHS with information on the most efficient way of using new technologies. Data from five major trials of statins and 18 randomised controlled trials showed that statins reduced overall mortality in people with cardiovascular disease by 21% and deaths from coronary heart disease by 26% The report considered that statins were less effective when used for primary prevention. In people with no evidence of cardiovascular disease, statin treatment reduced morbidity (such as non-fatal myocardial infarctions) but not overall or cardiovascular deaths.

    In the trials considered in the review the cost effectiveness of statins ranged from £5400 ($8640) to £13300 per life year gained in primary prevention and from £3800 to £9300 for secondary prevention, varying according to the cost of the statin and the risk of coronary heart disease in the population treated. This was much higher than the cost effectiveness of aspirin, which was calculated as being £53 per life year saved, and of other treatments for cardiovascular disease, such as antihypertensive regimens (£1509), b blockers after myocardial infarction (£227), and a Mediterranean diet after a myocardial infarction (£293). But even at their higher cost, the use of statins was considered to be acceptable in secondary prevention because of the benefits.

    Dr Nick Payne, senior lecturer in public health medicine at the School of Health and Related Research at the University of Sheffield and an author of the report, commented that the review indicated that hypercholesterolaemia in isolation should not be treated with statins. “The level of risk is an important assessment when making a decision to treat, especially for primary prevention of coronary heart disease. Age, sex, blood pressure, smoking, and diabetes status all need to be taken into account, as well as cholesterol level,” he said.

    Lowering the price of statins would greatly improve their cost effectiveness and would allow more patients to be treated, according to the review It said that “there may be a case for further examining the prices of statins, given the very large potential market of these drugs in primary prevention.”

    What Role for Statins? A Review and Economic Model can be ordered (free to staff working in the UK public sector) via fax (01703 595639) or email (hta{at}

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    Cross section of an atheromatous plaque in a human artery


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