They analyzed the impact of giving statins to people who currently do not have high heart risks and found that the drugs were well worth the extra cost of the treatment.
The study follows the findings of a major heart study two years ago dubbed Jupiter that found giving the AstraZeneca statin drug Crestor or rosuvastatin to people with average to low cholesterol but other heart risks helped prevent heart attack and strokes.
In that study, patients had low cholesterol but high levels of C-reactive protein, or CRP, a sign of inflammation that could mean a higher risk of heart attacks or strokes.
Under current guidelines, doctors recommend statins if people have a 20 percent or greater risk of having a heart attack or a stroke in the next 10 years.
The latest study looked to see if giving statins to more people would be worth the extra cost — something on the minds of U.S. politicians and insurers seeking to find ways to save costs as part of healthcare reform. Countries with national healthcare systems are also looking for ways to save money.
The team tested two strategies — either simply giving statins to more people or only giving them to people with a high CRP test.
“The real message is that either one of those strategies looked better than what we do now,” said Dr. Mark Hlatky of the Stanford University School of Medicine in California, whose study was published in the journal Circulation.
“Of the two alternatives, the idea of just lowering the threshold and not bothering with the CRP test came out ahead,” Hlatky said in a telephone interview.
His team developed a computer model that analyzed three approaches: following current guidelines; treating people who do not meet current guidelines but have high CRP; and treating those who have heart risks but do not meet current guidelines for getting statins.
QUALITY OF LIFE
The researchers evaluated cost based on a well-tested formula called quality-adjusted-life years that takes into account the cost of treatment, patient quality of life and how long they live. Typically, treatments that cost less than $50,000 per quality-adjusted-life year are seen as cost-effective.
The team found that giving statins based on risk was the most cost-effective.
“The critical thing was getting more people treated who don’t currently meet the guidelines,” Hlatky said.
But even slight changes in the assumptions — such as the safety of statin drugs — could tip the finding back to the status quo.
“We probably need more information still on how safe and effective these drugs are in low-risk populations,” he said.
A National Heart, Lung, and Blood Institute panel is updating the clinical guidelines for statin therapy. “Maybe the threshold for statin treatment ought to be lower than is currently recommended,” he said in a statement.
Statins — the world’s top-selling drugs — have been so effective at lowering low-density lipoprotein or LDL, the so-called “bad” cholesterol, that some doctors have jokingly suggested they should be added to the public water supply.
Not only do they significantly cut the risk of heart attack and stroke but they may reduce the risk of death from influenza, pneumonia and smoking.
Many brands such as Merck & Co Inc’s Zocor, are now generic, and many more will soon go off patent, making the drugs even more affordable.