Intended for healthcare professionals


Use of statins

BMJ 1997; 315 doi: (Published 13 December 1997) Cite this as: BMJ 1997;315:1615

Adequacy of SMAC's statement should be judged by clinicians, not health economists

  1. Peter Enoch, Chairman, Standing Medical Advisory Committeea
  1. a Littlewick Medical Centre, Ilkeston, Derbyshire DE7 5PR
  2. b School of Health and Related Research, University of Sheffield, Sheffield S1 4DA
  3. c Enfield and Haringey Health Authority, Barnet, Hertfordshire EN4 0DR
  4. d PHARMAC, PO Box 20-253, Wellington, New Zealand
  5. e University of British Columbia, Vancouver, BC, Canada
  6. f St Thomas's Hospital, London SE1 7EH
  7. g Burton Hospitals, Burton on Trent DE13 0RB
  8. h Faculty of Public Health Medicine, 4 St Andrews Place, London NW1 4LB
  9. i Royal Free Hospital and School of Medicine (University of London), London NW3 2QG
  10. j MRC Clinical Research Initiative in Heart Failure, University of Glasgow, Glasgow G12 8QQ
  11. k Department of Economics, City University, London EC1V 0HB
  12. l Scottish MONICA Project, Royal Infirmary, Glasgow G31 2ER
  13. m Dudley Health Authority, Dudley, West Midlands DY1 2DD
  14. n Vauxhall Primary Health Care, Liverpool L5 8XR
  15. o Section of Clinical Pharmacology and Therapeutics, Department of Medicine and Pharmacology, Royal Hallamshire Hospital, Sheffield S10 2JF
  16. p Medical Care Research Unit, Sheffield Centre for Health and Related Research, Sheffield S1 4DA
  17. q Department of Cardiology, Northern General Hospital, Sheffield S5 7AU
  18. r Department of Medicine, Middlesex Hospital, London W1N 8AA
  19. s Department of Pathological Biochemistry, Royal Infirmary, Glasgow G4 0SF
  20. t MRC Lipoprotein Team, Hammersmith Hospital, London W12 0HS
  21. u Department of Medicine B, University of Oslo, Rikshospitalet, Oslo, Norway
  22. v Department of Medicine, University of Oslo, Aker Hospital, Oslo

    See editorial by Muldoon

    Editor—Freemantle et al's editorial argues that the statement on the use of statins in coronary heart disease prepared by the Standing Medical Advisory Committee and issued recently by the NHS Executive is “simply inadequate.”1 2 The adequacy or otherwise of advice depends on the context in which it was issued and whether it is appropriate for the purpose.

    The context was the dramatic increase in the prescribing of statins since the publication of two landmark randomised controlled trials (the 4S (Scandinavian simvastatin survival study)3 and WOSCOPS (the west of Scotland coronary prevention study)4). Guidance issued by the European Society of Cardiology advised treating those of the population with a risk of coronary heart disease of ≥=2% a year,5 and others have advocated treating those with a risk of ≥=1.5%. The annual cost to the NHS of treating all people with coronary heart disease and those with a ≥=1.5% risk of developing symptoms would be of the order of £3.5bn.

    Most statins will be prescribed by general practitioners, and it was for them that authoritative but concise interim advice was primarily needed. The Standing Medical Advisory Committee convened a representative working party, including health economists. Its views were unanimous and, as the statement makes clear, were based on careful consideration of the “clinical effectiveness, cost effectiveness and long term safety of statins.” The current information on statins is better than that available for most new drugs, although data on comparative cost effectiveness are incomplete. The priority for the NHS is to treat those who can derive appreciable benefit from statins but to obviate inappropriate prescribing. It was not assumed that all people in the three priority groups would necessarily be treated with a statin, but if the statement were followed then the resources …

    Correspondence to Dr T M Reynolds, Clinical Chemistry Department, Queen's Hospital, Burton upon Trent, Staffordshire DE13 0RB

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