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    Social value of statins merits actions to broaden treatment, improve adherence, study finds

    New evidence suggests that statins generate large survival and health benefits at the population level and shows that the social value of the survival gains are large and go predominantly to consumers, according to a study published in the October issue of Health Affairs.

    “Statins are considered a clinically important breakthrough for the treatment of cardiovascular disease,” one of the study’s authors Larry Liu, MD, PhD, senior director for global health economics and outcomes research at Pfizer, told Formulary. “Research has long suggested that statins are a cost-effective therapy. However, their social value at the US population level has not previously been studied.”

    Researchers at the Schaeffer Center for Health Policy and Economics at the University of Southern California examined National Health and Nutrition Examination Study (NHANES) data from 1987 (when the first statin was approved for use) to 2008.

    “First, we assessed the relationship between statin use and LDL cholesterol levels using real-world [NHANES] survey data,” Dr Liu explained. “Next, we estimated avoided deaths and avoided hospitalizations resulting from statin use. Third, we calculated the social value of statins by estimating how statin use affected long-term survival, using data that followed participants in a randomized trial of statin use for 15 years.”

    Dr Liu and colleagues then calculated the social value of these survival gains.

    The data suggest statin therapy reduced low-density lipoprotein levels by 18.8%, which translated into roughly 40,000 fewer deaths, 60,000 fewer hospitalizations for heart attacks, and 22,000 fewer hospitalizations for strokes in 2008.

    For people starting statin therapy in 1987 to 2008, the aggregate social value of statins was estimated to be $1.252 trillion. Consumers captured $947.4 billion (76%) of the total social value of the survival gains, after accounting for expenditures on statin use, which were an estimated $304.6 billion.

    To put these figures into context, the United States spent $2.3 trillion on healthcare in 2008, according to Dr Liu.

    “In addition, statin costs are now declining because of patent expirations for major statins such as Lipitor,” Dr Liu said. “The findings suggest that policy-makers should consider interventions at the patient and provider levels to encourage both therapy for untreated at-risk patients with high cholesterol and greater adherence after therapy is initiated.”

    Regarding cholesterol-lowering medicines, American Heart Association/American College of Cardiology and European Atherosclerosis Society/European Society of Cardiology guidelines emphasize the importance of evidence-based treatment decisions and recommend physicians consider the use of cardiovascular medications that have been proven in clinical trials.

    “A wealth of clinical evidence supporting statins revolves around Lipitor, which has been proven in multiple clinical trials to reduce the risk of heart attack and stroke in many high-risk patients—those with coronary heart disease and those with diabetes and other risk factors,” Dr Liu said.