Statins Remain Cost Effective, Not Cost Saving

Today’s Managing Health Care Costs Indicator is $169,549

Click on image to enlarge.  Source below

Statins are enormously effective drugs that, along with a decrease in cigarette smoking, have been responsible for a huge decrease in the incidence of cardiac death, especially in young men.    Statins were shown to be effective  at lowering mortality in 1994  in the 4S study (Scandinavian Simvastatin Survival Study).   This study was reevaluated in 1996 to look at changes in hospital costs, and the saved hospitalizations in the treatment group covered 88% of the cost of simvastatin in the high risk group.  

Simvastatin has been a generic medication for a few years, and atorvastatin (Lipitor) is going generic this coming month. Have we finally reached a point where the use of statins is not merely cost-effective, but is actually cost-saving?

Even with dramatic declines in the acquisition cost of the statin medications, though, treatment in this simulation done in BMJ this past March was not cost-saving in any cohort.  The cost of a Quality Adjusted Life Year for a 55 year old man with a 5% ten year risk of a heart attack was 125,544 euros (or  almost $170K)

Harvard Link

Non-Harvard Link  

As you can see from the graphic – the cost to save lives with simvastatin was actually quite modest in many instances - especially over the longer time horizons. For instance, it cost only 5394 Euros for each QALY for 55 year old men at a 30% risk for a vascular event over the following 10 years. Still, not a single simulated group gained QALYs with LOWER costs. 

We don’t save money by using even generic statins for primary prevention of heart of vascular disease.   We only gain good health outcomes for a reasonable cost -- which doesn’t seem to me to be a bad outcome at all.

Prevention is a Good Deal - But it's the Vaccines that Save Money!

Today’s Managing Health Care Cost Indicator is 2.3 million

Double click to enlarge image.  Last column header is "net medical costs per person per year" 

That’s how many quality adjusted life years we could gain if we achieved 90% preventive care.

Maciosek and colleagues at Health Partners in Minneapolis performed a literature review and did economic forecasts and concluded that it would cost just $72 billion annually to achieve 90% adherence to preventive guidelines. 

The authors estimate that we would save $62 billion dollars in preventable medical costs by dramatically increasing preventive care. Thus we could save 2.3 million quality adjusted life years for just $10 billion dollars, a measly 0.6% of total health care spending. (That’s a bit over $4000 per QALY – much better than most medical care!)

Honestly - there isn't a better deal around - and we should sign up.

But let's not lose track of where the savings really are in preventive care.  Immunizations, counseling to use aspirin, smoking cessation, and a handful of other things save money. Immunizations in fact are genuinely cost saving, and are calculated to save $322 per person annually, while the entire bundle of preventive services saves only $48 per person.  

So – we should approach immunizations as a public health imperative as well as a good deal.  Some states (Massachusetts is one) have purchased childhood vaccine for all children regardless of income or health care coverage - and as a result achieve VERY high rates of immunization.  In Massachusetts, funding for this program has been maintained temporarily year to year.    Many states are cutting back on their vaccination programs because of declining state revenue.

There are very few genuinely cost saving therapies in health care – and even most preventive care just offers better outcomes at a reasonable price.  Vaccinations are an exception. Let’s invest in them.