More on Pravastatin and Coronary Disease

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Abstract
In a recent letter to the editor (May 16 issue),1 Rogers raised questions about the cost effectiveness of treatment of hypercholesterolemia. His calculations were derived from the West of Scotland Coronary Prevention Study.2 I propose that a more sober account of cost effectiveness is in order. There are three major issues concerning the use of cholesterol-lowering drugs to prevent coronary heart disease: efficacy, safety, and cost effectiveness. A recent cost analysis of the use of 3-hydroxy-3-methylglutaryl–coenzyme A reductase inhibitors (statins) in secondary prevention indicated a high degree of cost effectiveness.3 Costs were much lower than for many other accepted forms of medical therapy. Cost-effectiveness analyses based on the West of Scotland study are currently being carried out for high-risk primary prevention. Their results have not yet been published. However, preliminary estimates made with approaches similar to those used for secondary prevention suggest that the cost effectiveness of cholesterol-lowering drugs for primary prevention in high-risk patients will approximate that of other accepted forms of medical therapy. It is anticipated that cost effectiveness will improve even more in a few years, when the price of statins declines as patents expire.

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