, Volume 14, Issue 1, pp 59–70

The Cost of Reaching National Cholesterol Education Program (NCEP) Goals in Hypercholesterolaemic Patients

A Comparison of Atorvastatin, Simvastatin, Lovastatin and Fluvastatin
  • Michael J. Koren
  • Dean G. Smith
  • Donald B. Hunninghake
  • Michael H. Davidson
  • James M. McKenney
  • Stuart R. Weiss
  • Robert W. HenleyJr
  • Perry Tresh
  • Richard W. McLain
  • Rebecca G. Bakker-Arkema
  • Donald M. Black
Original Research Article Costs and NCEP Goals


Objective: Recognising the importance of treating hyperlipidaemia, the National Cholesterol Education Program (NCEP) has established widely accepted treatment goals for low density lipoprotein cholesterol (LDL-C). Medications used most commonly to achieve these LDL-C goals are HMG-CoA reductase inhibitors. The relative resource utilisation and cost associated with the use of reductase inhibitors of different LDL-C lowering efficacy are unknown, but are major health and economic concerns. The objective of this study was to determine the mean total cost of care to reach NCEP goals with various reductase inhibitors.

Design: In a randomised, 54-week, 30-centre controlled trial we compared resources used and costs associated with treating patients to achieve NCEP goals using 4 reductase inhibitors: atorvastatin, simvastatin, lovastatin and fluvastatin.

Patients and Participants: The trial studied 662 patients; 318 had known atherosclerotic disease.

Interventions: Reductase inhibitor therapy was initiated at recommended starting doses and increased according to NCEP guidelines and package insert information. For patients who did not reach the goal at the highest recommended dose of each reductase inhibitor, the resin colestipol was added.

Main outcome measures and results: Patients treated with atorvastatin, compared with other reductase inhibitors, were more likely to reach NCEP goals during treatment (p < 0.05), required fewer office visits (p < 0.001) and less adjuvant colestipol therapy (p = 0.001). Consequently, the mean total cost of care (1996 values) to reach NCEP goals was lower with atorvastatin [$US1064; 95% confidence interval (CI): $US953 to $US1176] compared with simvastatin ($US1471; 95% CI: $US1304 to $US1648), lovastatin ($US1972; 95% CI: $US1758 to $US2186) and fluvastatin ($US1542; 95% CI: $US1384 to $US1710). Results were similar for patients with or without known atherosclerotic disease.

Conclusions: In patients requiring drug therapy for hypercholesterolaemia, NCEP LDL-C goals are achieved significantly more often using fewer resources with atorvastatin compared with simvastatin, lovastatin or fluvastatin.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    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; 269: 3015–23Google Scholar
  2. 2.
    Scandinavian Simvastatin Survival Study Group. Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344: 1383–9Google Scholar
  3. 3.
    Shepherd J, Cobbe SM, Ford I, West of Scotland Coronary Prevention Study Group, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995; 333 (20): 1301–7PubMedCrossRefGoogle Scholar
  4. 4.
    Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med 1996; 335 (14): 1001–9PubMedCrossRefGoogle Scholar
  5. 5.
    Buchwald H, Varco RL, Matts JP, et al. Effect of partial ileal bypass surgery on mortality and morbidity from coronary heart disease in patients with hypercholesterolemia: report of the Program on the Surgical Control of the Hyperlipidemias (POSCH). N Engl J Med 1990; 323: 946–55PubMedCrossRefGoogle Scholar
  6. 6.
    Anderson KM, Castelli WP, Levy D. Cholesterol and mortality: 30 years of follow-up from the Framingham Study. JAMA 1987; 257 (16): 2176–80PubMedCrossRefGoogle Scholar
  7. 7.
    Holme I. An analysis of randomized trials evaluating the effect of cholesterol reduction on total mortality and coronary heart disease incidence. Circulation 1990; 82: 1916–24PubMedCrossRefGoogle Scholar
  8. 8.
    Frick MH, Elo O, Haapa K, et al. Helsinki Heart Study: primary- prevention trial with gemfibrozil in middle-aged men with dyslipidemia. N Engl J Med 1987; 317: 1237–45PubMedCrossRefGoogle Scholar
  9. 9.
    Goldman L, Weinstein MC, Goldman PA, et al. Cost-effectiveness of HMG-CoA reductase inhibition for primary and secondary prevention of coronary heart disease. JAMA 1991; 265: 1145–51PubMedCrossRefGoogle Scholar
  10. 10.
    Johannesson M, Jonsson B, Kjekshus J, et al. Cost effectiveness of simvastatin treatment to lower cholesterol levels in patients with coronary heart disease. N Engl J Med 1997; 336: 332–6PubMedCrossRefGoogle Scholar
  11. 11.
    Nawrocki JW, Weiss SR, Davidson MH, et al. Reduction of LDL-cholesterol by 25% to 60% in patients with primary hypercholesterolemia by atorvastatin, a new HMG-CoA reductase inhibitor. Arterioscler Thromb Vasc Biol 1995; 15: 678–82PubMedCrossRefGoogle Scholar
  12. 12.
    Zocor. Physicians desk reference. 49th ed. [atMontvale (NJ): Medical Economics Co., 1995: 1655–8Google Scholar
  13. 13.
    Mevacor. Physicians desk reference. 49th ed. Montvale (NJ): Medical Economics Co., 1995: 1584–8Google Scholar
  14. 14.
    Lescol. Physicians desk reference. 49th ed. Montvale (NJ): Medical Economics Co., 1995: 2165–8Google Scholar
  15. 15.
    Remmell PS, Gorder DD, Hall Y, et al. Assessing dietary adherence in the Multiple Risk Factor Intervention Trial (MRFIT), I: use of a dietary monitoring tool. JAMA 1980; 76: 351–6Google Scholar
  16. 16.
    Freidewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low density lipoprotein cholesterol in plasma without the use of a centrifuge. Clin Chem 1972; 18: 449–502Google Scholar
  17. 17.
    Lipid and lipoprotein analysis. In: The Laboratory Methods Committee, editors. Manual of laboratory operations: LRC program report (NIH). Vol. 1. Bethesda (MD): US Department of Health, Education, and Welfare, 1974: 75–628Google Scholar
  18. 18.
    Practice Management Information Corporation (PMIC). [tiPhysician fees: a comprehensive guide for fee schedule review and management. Los Angeles: PMIC, 1996Google Scholar
  19. 19.
    Drug topics red book. Montvale (NJ): Medical Economic Company Inc., 1996Google Scholar
  20. 20.
    Agramowitz M, editor. Atorvastatin: a new lipid-lowering drug. Med Lett Drugs Ther 1997; 39: 29–31Google Scholar
  21. 21.
    Lawless JF. Statistical models and methods for lifetime data. New York: Wiley, 1982Google Scholar
  22. 22.
    Montague TJ, Tsuyuki RT, Burton JR, et al. Prevention and regressions of coronary atherosclerosis: is it safe and efficacious therapy? Chest 1994; 105: 718–26PubMedCrossRefGoogle Scholar
  23. 23.
    American Heart Association. Heart and stroke facts [statistical supplement]. Dallas (TX): American Heart Association, 1996Google Scholar
  24. 24.
    Johnson CL, Rifkind BM, Sempos CT, et al. Declining serum total cholesterol levels among US adults: the national health and nutrition examination surveys. JAMA 1993; 269: 3002–8PubMedCrossRefGoogle Scholar
  25. 25.
    Giles WH, Anda RF, Jones DH, et al. Recent trends in the identification and treatment of high blood cholesterol by physicians. JAMA 1993; 269: 1133–8PubMedCrossRefGoogle Scholar
  26. 26.
    Pedersen TR, Kjekshus J, Berg K, et al. Cholesterol lowering and the use of healthcare resources: results of the Scandinavian Simvastatin Survival Study. Circulation 1996; 93 (10): 1796–802PubMedCrossRefGoogle Scholar
  27. 27.
    Jonsson B, Johannesson M, Kjekshus J, et al. Cost-effectiveness of cholesterol lowering: results from the Scandinavian Simvastatin Survival Study (4S). Eur Heart J 1996; 17 (7): 1001–7PubMedCrossRefGoogle Scholar
  28. 28.
    Reckless JPD. The 4S Study and its pharmacoeconomic implications. Pharmacoeconomics 1996; 9 (2): 101–5PubMedCrossRefGoogle Scholar
  29. 29.
    Hamilton VH, Racicot FE, Zowall H, et al. The cost-effectiveness of HMG-CoA reductase inhibitors to prevent coronary heart disease: estimating the benefits of increasing HDL-C. JAMA 1995; 273 (13): 1032–8PubMedCrossRefGoogle Scholar
  30. 30.
    Pharoah PD, Hollingworth W. Cost effectiveness of lowering cholesterol concentration with statins in patinets with and without pre-existing coronary heart disease: life table method applied to health authority population. BMJ 1996; 312: 1443–8PubMedCrossRefGoogle Scholar
  31. 31.
    Ashraf T, Hay JW, Pitt B. Cost-effectiveness of pravastatin in secondary prevention of coronary artery disease. Am J Cardiol 1996; 78 (4): 409–14PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 1998

Authors and Affiliations

  • Michael J. Koren
    • 1
  • Dean G. Smith
    • 2
  • Donald B. Hunninghake
    • 3
  • Michael H. Davidson
    • 4
  • James M. McKenney
    • 5
  • Stuart R. Weiss
    • 6
  • Robert W. HenleyJr
    • 8
  • Perry Tresh
    • 9
  • Richard W. McLain
    • 9
  • Rebecca G. Bakker-Arkema
    • 9
  • Donald M. Black
    • 9
  1. 1.Jacksonville Center for Clinical ResearchJacksonvilleUSA
  2. 2.Department of Health Management and PolicyUniversity of MichiganAnn ArborUSA
  3. 3.Departments of Medicine and PharmacologyUniversity of MinnesotaMinneapolisUSA
  4. 4.Chicago Center for Clinical ResearchChicagoUSA
  5. 5.National Clinical ResearchRichmondUSA
  6. 6.The San Diego Endocrine & Medical Clinic, Inc.San DiegoUSA
  7. 7.Departments of Preventive Medicine and Internal MedicineUniversity of IowaIowa CityUSA
  8. 8.Cardiovascular Associates of VirginiaRichmondUSA
  9. 9.Parke Davis Pharmaceutical ResearchDivision of Warner-Lambert CompanyAnn ArborUSA

Personalised recommendations