Cholesterol Lowering and the Use of Healthcare Resources
- 15 May 1996
- journal article
- clinical trial
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 93 (10), 1796-1802
- https://doi.org/10.1161/01.cir.93.10.1796
Abstract
Background Advances in the treatment of cardiovascular disease have increased costs; annual cardiovascular healthcare expenditure in the United States currently exceeds $100 billion. Physicians and third-party payers need to assess the economic impact of treatments that reduce cardiovascular morbidity and mortality. Methods and Results The Scandinavian Simvastatin Survival Study is a randomized, double-blind, placebo-controlled trial in which simvastatin reduced the risk of death by 30% ( P =.0003) over the median follow-up period of 5.4 years in patients with previous myocardial infarction or stable angina pectoris as a result of a 42% reduction in the risk of coronary deaths ( P =.00001). In the present report, data prospectively collected from hospital admissions were analyzed to evaluate the impact of simvastatin on healthcare resource use and perform a cost-minimization analysis. In the placebo group (n=2223), there were 1905 hospitalizations (average duration, 7.9 days) for acute cardiovascular events or coronary revascularization procedures among 937 patients, whereas in the simvastatin group (n=2221), there were 1403 such hospitalizations (average duration, 7.1 days) among 720 patients (all differences, P <.0001). The corresponding number of hospital days was 15 089 and 9951 in the two groups, respectively (34% reduction, P <.0001). In the United States, the resulting reduction in hospitalization costs over the 5.4 years of the trial would be $3872 per patient, reducing the effective cost of simvastatin by 88% to $0.28 per day. Conclusions In addition to reducing mortality and morbidity in coronary heart disease patients, simvastatin markedly reduces use of hospital services, thus offsetting most of its cost.Keywords
This publication has 11 references indexed in Scilit:
- Baseline serum cholesterol and treatment effect in the Scandinavian Simvastatin Survival Study (4S)The Lancet, 1995
- By how much and how quickly does reduction in serum cholesterol concentration lower risk of ischaemic heart disease?BMJ, 1994
- Summary of the Second Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II)JAMA, 1993
- Cost effectiveness of incremental programmes for lowering serum cholesterol concentration: is individual intervention worth while?BMJ, 1991
- Cost-effectiveness of HMG-CoA Reductase Inhibition for Primary and Secondary Prevention of Coronary Heart DiseasePublished by American Medical Association (AMA) ,1991
- Clinical benefits and cost-effectiveness of lowering serum cholesterol levels: The case of simvastatin and cholestyramine in The NetherlandsThe American Journal of Cardiology, 1990
- A sharper Bonferroni procedure for multiple tests of significanceBiometrika, 1988
- Cutting Into CholesterolPublished by American Medical Association (AMA) ,1988
- Cost-effectiveness of Antihyperlipemic Therapy in the Prevention of Coronary Heart DiseaseJAMA, 1987
- Cox's Regression Model for Counting Processes: A Large Sample StudyThe Annals of Statistics, 1982