High-dose statins not cost-effective for all patients

Research suggests that patients at lower risk of cardiovascular events might not get their money's worth from taking more of these medications.

By Victoria Stagg Elliott, AMNews staff. May 14, 2007.

Questions about the cost and benefit of high-dose statin regimens for patients with coronary disease have become a hot topic. A study published in the May 8 issue of Circulation takes on the issue, finding different answers depending on the severity of their illness.

"High doses in acute coronary syndrome patients should be the standard of care. It's not only effective. It's cost-effective. The use of high-dose statins in stable coronary artery disease patients is less clear," said Paul S. Chan, MD, lead author and a cardiovascular fellow at the University of Michigan Medical School in Ann Arbor.

Researchers created several computer simulations comparing the impact of high and conventional dosages of statins over the life of a hypothetical group of 60-year-olds. Those with acute disease gained an average of 0.35 quality-adjusted life years by using the more-intensive regimen. Even when the price differential was great between the two options, the expense was less than $30,000 per year of quality life gained. Patients with stable disease gained an average of only 0.10 years -- and at great cost.

"We may want to think twice in the stable population with regard to price and in terms of incremental gains for high-dose statins," said Dr. Chan, who also is a member of the VA Health Services Research and Development Center of Excellence, also in Ann Arbor.

Several studies have found that higher doses improve outcomes by reducing the total number of negative endpoints, including deaths, cardiovascular events, hospitalizations and revascularizations. Researchers felt that there was a need to further parse out which patients get which benefits because some are more important than others. For example, in this study, higher-dose statins reduced mortality in acute patients but not in those with stable disease, although these patients did have fewer strokes and myocardial infarctions.