Abstract
The widespread use and high cost of lipid-lowing drugs have resulted in numerous investigations of their cost effectiveness. Pharmacoeconomic analyses have considered initiation of treatment, maintenance therapy, and long-term outcomes of lipid-lowering therapy. Analyses have yielded a number of consistent messages, but the story continues to evolve as new trials, models, and drugs are introduced. Certain medications are more efficacious and associated with more cost-effective lipid-lowering therapy initiation. Other medications are lower priced and may be more cost effective for maintenance, contingent upon having achieved lipid-lowering goals. Finally, some medications have proven long-term cost effectiveness in trials and comparative cost effectiveness in models. Research is certain to further our understanding of the costs of lipid-lowering therapy and the methods needed to optimize expenditures.
Similar content being viewed by others
References and Recommended Reading
Steinberg D, Gotto AM Jr: Preventing coronary artery disease by lowering cholesterol levels: fifty years from bench to bedside. JAMA 1999, 282:2043–2050.
Wong NN: Colesevelam: a new bile acid sequestrant. Heart Disease 2001, 3:63–70.
Siegel JE, Weinstein MC, Russell LB, Gold MR: Recommendations for reporting cost-effectiveness analyses. JAMA 1996, 276:1339–1341.
Weinstein MC, Toy EL, Sandberg EA, et al.: Modeling for health care and other policy decisions: uses, roles, and validity. Value Health 2001, 4:348–361.
Schulman KA, Kinosian B, Jacobson TA, et al.: Reducing high blood cholesterol level with drugs: cost-effectiveness of pharmacologic management. JAMA 1990, 264:3025–3033.
Oster G, Borok GM, Menzin J, et al.: Cholesterol-reduction intervention study (CRIS): a randomized trial to assess effectiveness and costs in clinical practice. Arch Intern Med 1996, 156:731–739.
Thompson D, Oster G: Cost-effectiveness of drug therapy for hypercholesterolaemia: a review of the literature. Pharmacoeconomics 1992, 2:34–42.
Hay JW, Yu WM, Ashraf T: Pharmacoeconomics of lipid-lowering agents for primary and secondary prevention of coronary artery disease. Pharmacoeconomics 1999, 15:47–74.
Lousberg TR, Denham AM, Rasmussen JR: A comparison of clinical outcome studies among cholesterol-lowering agents. Ann Pharmacother 2001, 35:1599–1607.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001, 285:2486–2497.
Black D, Davidson M, Koren M, et al.: Cost effectiveness of treatment to National Cholesterol Education Panel (NCEP) targets with HMG-CoA reductase inhibitors: trial design. Pharmacoeconomics 1997, 12:278–285.
Smith DG, Leslie SJ, Szucs TD, et al.: Cost of treating to a modified European Atherosclerosis Society LDL-C target: comparison of atorvastatin versus fluvastatin, pravastatin and simvastatin. Clin Drug Invest 1999, 17:185–193.
Koren MJ, Smith DG, Hunninghake DB, et al.: The cost of reaching National Cholesterol Education Program (NCEP) goals in hypercholesterolaemic patients: a comparison of atorvastatin, simvastatin, lovastatin and fluvastatin. Pharmacoeconomics 1998, 14:59–70.
Smith DG, Berger K, Rudolph C, Albright J: Comparing the cost-effectiveness of atorvastatin with cerivastatin in treating patients to LDL-C target levels. Atherosclerosis 2001, 2(suppl):57.
Maclaine GD, Patel H: A cost-effectiveness model of alternative statins to achieve target LDL-cholesterol levels. Int J Clin Practice 2001, 55:243–249.
Staffa JA, Chang J, Green L: Cerivastatin and reports of fatal rhabdomyolysis. N Engl J Med 2002, 346:539–440.
Pasternak RC, Smith SC, Bairey-Merz CN, et al.: ACC/AHA/NHLBI clinical advisory on the use and safety of statins. J Am Coll Cardiol 2002, 40:568–573.
McPherson R, Hanna K, Agro A, Braeken A: Cerivastatin versus branded pravastatin in the treatment of primary hypercholesterolemia in primary care practice in Canada: a one-year, open-label, randomized, comparative study of efficacy, safety, and cost-effectiveness. Clin Ther 2001, 23:1492–1507.
Grace KA, Swiecki J, Hyatt R, et al.: Implementation of a therapeutic-interchange clinic for HMG-CoA reductase inhibitors. Am J Health System Pharm 2002, 59:1077–1082.
Latts LM: Assessing the results: phase 1 hyperlipidemia out-comes in 27 health plans. Am J Med 2001, 17S–23S.
Coombs JH, Cornish L, Hiller P, Smith DG: Compliance and refill pattern behavior with HMG-CoA reductase inhibitors after acute myocardial infarction. Managed Care Interface 2002, 15:54–60.
Attanasio E, Russo P, Allen SE: Cost-minimization analysis of simvastatin versus atorvastatin for maintenance therapy in patients with coronary or peripheral vascular disease. Clin Ther 2001, 23:276–283.
Chong PH, Seeger JD, Franklin C: Clinically relevant differences between the statins: implications for therapeutic selection. Am J Med 2001, 111:390–400.
Caro J, Klittich W, McGuire A, et al.: International economic analysis of primary prevention of cardiovascular disease with pravastatin in WOSCOPS: West of Scotland Coronary Prevention Study. Eur Heart J 1999, 20:263–268.
Downs JR, Clearfield M, Weis S, et al.: Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS: Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA 1998, 279:1615–1622.
Johannesson M, Jonsson B, Kjekshus J, et al.: Cost effectiveness of simvastatin treatment to lower cholesterol levels in patients with coronary heart disease: Scandinavian Simvastatin Survival Study Group. N Engl J Med 1997, 336:332–336.
Pitt B, Waters D, Brown WV, et al.: Aggressive lipid-lowering therapy compared with angioplasty in stable coronary artery disease. N Engl J Med 1999, 341:70–76.
Bazalo GR: Managed care trends in statin usage. Managed Care 2001, 10:48–50.
Wallis EJ, Ramsay LE, Haq IU, et al.: Coronary and cardiovascular risk estimation for primary prevention: validation of a new Sheffield table in the 1995 Scottish health survey population. BMJ 2000, 320:671–676.
van Hout BA, Simoons ML: Cost-effectiveness of HMG coenzyme reductase inhibitors; whom to treat? Eur Heart J 2001, 22:751–761.
Prosser LA, Stinnett AA, Goldman PA, et al.: Cost-effectiveness of cholesterol-lowering therapies according to selected patient characteristics. Ann Intern Med 2000, 132:769–779.
Nyman JA, Martinson MS, Nelson D, et al.: Cost-effectiveness of gemfibrozil for coronary heart disease patients with low levels of high-density lipoprotein cholesterol: the Department of Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial. Arch Intern Med 2002, 162:177–182.
Tsevat J, Kuntz KM, Orav EJ, et al.: Cost-effectiveness of pravastatin therapy for survivors of myocardial infarction with average cholesterol levels. Am Heart J 2001, 141:727–734.
Ganz DA, Kuntz KM, Jacobson GA, Avorn J: Cost-effectiveness of 3-hydroxy-3- methylglutaryl coenzyme A reductase inhibitor therapy in older patients with myocardial infarction. Ann Intern Med 2000, 132:780–787.
Lemaitre RN, Psaty BM, Heckbert SR, et al.: Therapy with hydroxymethylglutaryl coenzyme a reductase inhibitors (statins) and associated risk of incident cardiovascular events in older adults: evidence from the Cardiovascular Health Study. Arch Intern Med 2002, 162:1395–1400.
Black DM: Statins in children: what do we know and what do we need to do? Curr Atheroscler Rep 2001, 3:29–34.
Ballesteros LC, Fernandez San Martin MI, Sanz Cuesta T, et al.: The cost of inadequate prescriptions for hypolipidaemic drugs. Pharmacoeconomics 2001, 19:513–522.
Avorn J, Monette J, Lacour A, et al.: Persistence of use of lipid-lowering medications: a cross-national study. JAMA 1998, 279:1458–1462.
Caro JJ, Huybrechts KF, De Backer G, et al.: Are the WOSCOPS clinical and economic findings generalizable to other populations? A case study for Belgium. Acta Cardiol 2000, 55:239–246.
Perreault S, Levinton C, Le Lorier J: Efficacy and cost of HMG-CoA reductase inhibitors in the treatment of patients with primary hyperlipidemia. Can J Clin Pharmacol 2000, 7:144–154.
Rockson SG: Benefits of lipid-lowering agents in stroke and coronary heart disease: pharmacoeconomics. Curr Atheroscler Rep 2000, 2:144–150.
Jackson G: The role of statins in acute coronary syndromes: managing the unmet need. Int J Clin Pract 2000, 54:445–449.
The CDC Diabetes Cost-effectiveness Group: Cost-effectiveness of intensive glycemic control, intensified hypertension control, and serum cholesterol level reduction for type 2 diabetes. JAMA 2002, 287:2542–2551.
Jick H, Zornberg GL, Jick SS, et al.: Statins and the risk of dementia. Lancet 2000, 356:1627–1631.
Lee TH, Cleeman JI, Grundy SM, et al.: Clinical goals and performance measures for cholesterol management in secondary prevention of coronary heart disease. JAMA 2000, 283:94–98.
Hilleman DE, Wurdeman RL, Lenz TL: Therapeutic change of HMG-CoA reductase inhibitors in patients with coronary artery disease. Pharmacotherapy 2001, 21:410–415.
Taylor AJ, Grace K, Swiecki J, et al.: Lipid-lowering efficacy, safety, and costs of a large-scale therapeutic statin formulary conversion program. Pharmacotherapy 2001, 21:1130–1139.
Brown BG, Zhao XQ, Chait A, et al.: Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med 2001, 345:1583–1592.
Gotto AM Jr: Management of dyslipidemia. Am J Med 2002, 112:10S-18S.
Isaacsohn J, Black D, Troendle A, Orloff D: The impact of the National Cholesterol Education Program Adult Treatment Panel III guidelines on drug development. Am J Cardiology 2002, 89:45C-49C.
Cardinale V: Drug Topics Red Book. Montvale, NJ: Medical Economics; 2000.
ADP Context, Inc.: Physician Fees. Rockville, MD: ADP Context; 2000.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Smith, D.G. Pharmacoeconomics of lipid-lowering drugs. Curr Atheroscler Rep 5, 67–72 (2003). https://doi.org/10.1007/s11883-003-0070-6
Issue Date:
DOI: https://doi.org/10.1007/s11883-003-0070-6