Societal Benefit of Statins: $1,000,000,000

October 17, 2012 (Boston, Massachusetts) — Statins prevented more than 40 000 deaths in 2007 and more than 61 000 hospitalizations for MI and 22 000 hospitalizations for stroke in 2008, according to a US analysis assessing the social value of the lipid-lowering drugs. Based on the average costs attributable to these clinical events, the use of statins avoided $4.4 billion and $440 million in MI and stroke hospitalization costs, respectively.

When the researchers considered the mortality benefits alone, statin therapy generated a $974.4 billion "consumer surplus" for people beginning statin therapy over the period between 1997 and 2008.

"If we extended our calculations to the 27 countries in the European Union, the estimates of social value would be even larger, possibility by one-half," according to Dr David Grabowski (Harvard Medical School, Boston, MA) and colleagues, writing in the October 2012 issue of Health Affairs. "These estimates are likely to rise in the future, as baby boomers age and the clinical effects of obesity manifest themselves."

Based on the National Health and Nutrition Examination Survey (NHANES), the researchers estimated that approximately 34.8 million Americans aged 20 years of age and older were using statins. Using the current clinical guidelines, they also estimated that an additional 20 million adults were untreated but should be taking lipid-lowering medications.

From 1999 to 2008, the average LDL-cholesterol level of statin users was 21.6 mg/dL lower than the average LDL-cholesterol level of nonusers. Using this reduction in LDL-cholesterol level for the overall population, the group modeled the effect of statins on mortality and hospitalizations using data from a 2010 meta-analysis of 170 000 participants in 26 randomized trials.

A decline of 21.6 mg/dL among the 34.8 million Americans estimated to use statins would have prevented 40 020 deaths in 2007 and 61 074 MI hospitalizations and 22 272 stroke hospitalizations in 2008. If the additional patients who qualified for statin therapy were taking the drugs, statin therapy would have prevented an additional 23 000 deaths, 34 450 MI hospitalizations, and 12 800 stroke hospitalizations. If all patients were treated according to the clinical guidelines, the use of statins would have avoided an additional $2.5 billion for MI hospitalization costs and $260 million in stroke hospitalization costs.

The social value of statins was calculated using the average longevity benefit of 14.7 years from the West of Scotland Prevention Study (WOSCOPS). The value of the survival gains was based on an unadjusted life-year being worth $150 000, discounted at 3% annually. At this rate, the social value of statins was calculated to be $1.2 trillion, while the costs were $304.6 billion, yielding a total benefit, or consumer surplus, of $947.4 billion.

"In light of the large social value that we found associated with statins, coupled with the high rate of nonadherence, insurers may want to go beyond eliminating copayments for statins and develop programs to increase their use," state Grabowski and colleagues. "These programs could include financial incentives, educational interventions, and other nonpecuniary rewards for medication adherence."

Given the expiration of patents on simvastatin and atorvastatin and the entry of a number of generic statins into the market, the price reduction is likely to produce even larger economic benefits associated with statins.

References

• Grabowski DC, Lakdawalla DN, Goldman DP, et al. The large social value resulting from use of statins warrants steps to improve adherence and broaden treatment. Health Aff 31;2276-2285. Abstract.


By Michael O'Riordan, Medscape
Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP

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