Prescription of statins: cost implications of evidence-based treatment applied to a health authority population.

OBJECTIVE

To examine the amount spent on cardiovascular drugs and coronary services in one health authority and to estimate the cost of translating recent trial evidence for HMG-CoA reductase inhibitors (statins) into clinical practice.

METHOD

Prescription and hospital activity data over a 2-year period were analysed retrospectively for 449 834 patients of 89 general medical practices. The average annual amount spent on these patients was calculated for eight cardiovascular drug groups defined in the British National Formulary (BNF), hospitalizations for ischaemic heart disease, and revascularization and angiography procedures. The proportion of the study population with the potential to benefit from treatment with statins was then determined by identifying individuals with the characteristics of participants who benefited in any one of three published clinical trials. Identification of these individuals was assisted by the use of population-specific morbidity data and serum cholesterol levels reported in published surveys.

RESULTS

The actual average annual expenditure on statins (pound 774 per 1000 patients registered) was lower than that on ACE inhibitors, beta-adrenoceptor blockers, calcium channel blockers, diuretics and nitrates and was less than one-tenth of the combined annual cost of all coronary hospitalizations examined. In the patient population studied it was estimated that 7547 (1.7%) individuals would be eligible for secondary prevention with statins whilst 20406 (4.5%) would be eligible for primary prevention. After adjusting for possible non-adherence, the estimated annual cost of statin treatment for all such individuals was calculated to be between pound 22 599 and pound 28 413 per 1000 of the study population. Application of these figures to the registered population of the health authority would add approximately pound 11.8 million to a pound 60 million primary and secondary care drugs budget. It is proposed that statin treatment will have to be prioritized for those at highest risk, whilst maintaining a population-based strategy of promoting lifestyle advice to reduce the risk of cardiovascular events.