Intended for healthcare professionals

Rapid response to:

Primary Care

Coronary heart disease prevention: insights from modelling incremental cost effectiveness

BMJ 2003; 327 doi: (Published 27 November 2003) Cite this as: BMJ 2003;327:1264

Rapid Response:

Simvastatin will be the "New Aspirin", even on Price

Tom Marshall (1) is almost certainly correct with the conclusions of
his paper, and I would go further: the expenditure on "statins" for
patients at high risk, by the NHS, has in all probability resulted in more
people dying, because of lost opportunity costs, than they have saved.

However the timing of his paper is most unfortunate. With Simvastatin
now "off patent", low cost generic supplies are now flooding into the
market. The Department of Health has just cut the price it pays to

But will the price fall from by the 70% that Marshall feels would be
necessary to match the cost effectiveness of initial hypertensive therapy
with bendroflumethazide and atenolol? The evidence is that it will.

The United States Department of Defense currently contract with
Merck(2) at 44 cents/ 20mg tablet (approximately £7.16/ pack).
I have recently been quoted £3.70/pack by a leading UK supplier, and
generics appear to be available around £2.00/pack in other countries (3).
The net ingredient cost is probably around £1.00/pack for 20mg tablets
(based on US$4780/kg)(4).

The wholesale price should continue to fall with time. How much the
NHS wishes to pay, however, is quite a different
matter. For the time being I am prepared to take the department of health
at their word that they "will keep reimbursement prices under review" (5),
and to support moving the prescribing of simvastatin on the NHS to those
with a 10year cardiovascular risk of greater than 20% {15% 10year CHD
risk), based on Framingham.

1. T.Marshall 2003;327:1264

2. www.pec.ha.osd




Competing interests:
None declared

Competing interests: No competing interests

05 December 2003
john s ashcroft
general practitioner
Old Station Surgery,Ilkeston,Derbyshire. DE72 3EA