Statins are one of the great success stories of preventive medicine. Extensive evidence, excellent safety, and high efficacy have resulted in an exponential rise in prescriptions for statins, currently increasing at 30% a year in England. Statins represent the largest drug cost to the NHS (£738 million (€1.1bn; $1.4bn) in 2004).1

Around 85% of all statin prescriptions in England are for simvastatin and atorvastatin, in roughly equal proportions, usually at moderate or low doses (98% of simvastatin is prescribed at ≤ 40 mg, 85% of atorvastatin at ≤ 20 mg). In May 2003 the UK simvastatin patent expired and the cost reduced eightfold for the 40 mg dose and 20-fold for the 20 mg dose. The maximum price of simvastatin 40 mg is now up to six times cheaper than atorvastatin (£3.89, £18.03, and £24.64 respectively for simvastatin 40 mg, atorvastatin 10 mg and 20 mg),2 and simvastatin 40 mg can cost less than £1 per patient per month when purchased in bulk by hospitals. This price fall alone will save the NHS £1bn over the next five years. Atorvastatin remains on patent …