Circ Cardiovasc Qual Outcomes. 2009 Mar;2(2):65-72. doi: 10.1161/CIRCOUTCOMES.108.808469. Epub 2009 Mar 5.
Statins reduce the rates of heart attacks, strokes, and revascularization procedures (ie, major vascular events) in a wide range of circumstances. Randomized controlled trial data from 20,536 adults have been used to estimate the cost-effectiveness of prescribing statin therapy in the United States for people at different levels of vascular disease risk and to explore whether wider use of generic statins beyond the populations currently recommended for treatment in clinical guidelines is indicated.
Randomized controlled trial data, an internally validated vascular disease model, and US costs of statin therapy and other medical care were used to project lifetime risks of vascular events and evaluate the cost-effectiveness of 40 mg simvastatin daily. For an average of 5 years, allocation to simvastatin reduced the estimated US costs of hospitalizations for vascular events by approximately 20% (95% CI, 15 to 24) in the different subcategories of participants studied. At a daily cost of $1 for 40 mg generic simvastatin, the estimated costs of preventing a vascular death within the 5-year study period ranged from a net saving of $1300 (95% CI, $15,600 saving to $13,200 cost) among participants with a 42% 5-year major vascular event risk to a net cost of $216,500 ($123,700 to $460,000 cost) among those with a 12% 5-year risk. The costs per life year gained with lifetime simvastatin treatment ranged from $2500 (-$40 to $3820) in people aged 40 to 49 years with a 42% 5-year major vascular event risk to $10,990 ($9430 to $14,700) in people aged 70 years and older with a 12% 5-year risk.
Treatment with generic simvastatin appears to be cost-effective for a much wider population in the United States than that recommended by current guidelines.
他汀类药物在多种情况下可降低心脏病发作、中风和血管重建手术（即重大血管事件）的发生率。来自20536名成年人的随机对照试验数据已被用于估计在美国为不同血管疾病风险水平的人群开具他汀类药物治疗的成本效益，并探讨是否表明应在临床指南目前推荐治疗的人群之外更广泛地使用通用他汀类药物。
使用随机对照试验数据、内部验证的血管疾病模型以及美国他汀类药物治疗和其他医疗护理的成本，来预测血管事件的终身风险，并评估每日40毫克辛伐他汀的成本效益。在平均5年的时间里，在研究的不同参与者亚组中，分配到辛伐他汀使血管事件住院的估计美国成本降低了约20%（95%CI，15%至24%）。对于每日成本为1美元的40毫克通用辛伐他汀，在5年研究期内预防血管死亡的估计成本范围从5年重大血管事件风险为42%的参与者中净节省1300美元（95%CI，节省15600美元至成本13200美元）到5年风险为12%的参与者中净成本216500美元（123700美元至460000美元）。终身使用辛伐他汀治疗每获得一个生命年的成本范围从5年重大血管事件风险为42%的40至49岁人群中的2500美元（-40美元至3820美元）到5年风险为12%的70岁及以上人群中的10990美元（9430美元至14700美元）。
在美国，与当前指南推荐的人群相比，使用通用辛伐他汀治疗对更广泛的人群似乎具有成本效益。
