Cost-effectiveness of simvastatin in people at different levels of vascular disease risk: economic analysis of a randomised trial in 20536 individuals

Background Statin therapy reduces the rates of heart attack, stroke, and revascularisation among a wide range of individuals. Reliable assessment of its cost-effectiveness in different circumstances is needed. Methods 20 536 adults (aged 40-80 years) with vascular disease or diabetes were randomly allocated 40 mg sinnivastatin daily (10 269) or placebo (10 267) for an average of 5 years. Comparisons were made of hospitalisation and statin costs (2001 UK prices) during the scheduled treatment period between all simvastatin-allocated versus all placebo-allocated participants. Cost-effectiveness was estimated among different categories of participant. Findings Allocation to simvastatin was associated with a highly significant 22% (95% Cl 16-27; p<0.0001) proportional reduction in hospitalisation costs for all vascular events, with similar proportional reductions in every subcategory of participant studied. During an average of 5 years, estimated absolute reductions in vascular event costs per person allocated 40 mg simvastatin daily ranged from UK 847 pound (SE 137) in the highest risk quintile studied to,[264 (48) in the lowest. Mean excess cost of statin therapy among participants allocated simvastatin was 1497 pound (8), with similar absolute increases in every subcategory. Costs of preventing a major vascular event with 40 mg simvastatin daily ranged from,C4500 (95% CI 2300-7400) among participants with a 42% 5-year major vascular event rate to 31 pound 100 (22 900-42 500) among those with a 12% rate (corresponding to 5-year major coronary event rates of 22% and 4%, respectively). Interpretation Statin therapy is cost effective for a wider range of individuals with vascular disease or diabetes than previously recognised (particularly with lower-priced generics). It would be appropriate to consider reducing the estimated level of vascular event risk at which statin therapy is recommended.