Education and debate

Paying for statins

BMJ 2004; 328 doi: 10.1136/bmj.328.7436.400 (Published 12 February 2004)
Cite this as: BMJ 2004;328:400

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  1. Nick Raithatha (N.Raithatha@uea.ac.uk), general practitioner1,
  2. Richard D Smith, reader in health economics2
  1. 1Health Centre, University of East Anglia, Norwich NR4 7TJ
  2. 2Health Economics and Ethics Group School of Medicine, Health Policy and Practice, University of East Anglia
  1. Correspondence to: N Raithatha
  • Accepted 16 December 2003

Should UK general practitioners be able to offer private prescriptions for statins to patients below 3% risk of heart disease?

Coronary heart disease is a major cause of illness in Britain, with around 100 000 deaths from 300 000 heart attacks annually.1 2 Raised cholesterol concentration is an important risk factor for coronary heart disease.3 Treatment with 3-hydroxy-3-methylglutaryl coenzyme reductase inhibitors (statins) significantly reduces cholesterol concentrations, decreasing the risk of heart attack by at least 33%4 and as much as 61% in the long term.5 Statins are relatively safe,6 and their benefit is additive to other preventive measures, such as aspirin.7 However, many people who could benefit from them are not currently receiving them, largely for economic reasons. This article explains the rationale for increasing prescribing of statins and suggests one way in which this could be afforded.

Cost of treatment

Current evidence shows that statins reduce the risk of developing coronary heart disease in people with a greater than 0.6% a year chance of developing the disease.8 However, the national service framework that establishes standards for the prevention of coronary heart disease recommends treatment only for people with a risk of over 3% a year.1 The cost effectiveness of statins (based on a benefit of 33%) has been estimated at £4500 ($8250, €6460) per life year gained for a year's treatment of people at a 3% annual risk of coronary heart disease and £6100 a year for people at a 1.5% annual risk; the net discounted cost per life year saved to the NHS is £7500 and £11 800 respectively. …

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