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Cost Effectiveness of HMG-CoA Reductase Inhibitors in the Management of Coronary Artery Disease

The Problem of Under-Treatment

American Journal of Cardiovascular Drugs volume 3, pages 179–191 (2003)Cite this article

Abstract

HMG-CoA reductase inhibitors significantly reduce the risk of coronary artery disease (CAD) events and CAD-related mortality in patients with and without established CAD. Consequently, HMG-CoA reductase inhibitors have a central role within recommendations for lipid-modifying therapy. However, despite these guidelines, only one-third to one-half of eligible patients receive lipid-lowering therapy and as few as one-third of these patients achieve recommended target serum levels of low density lipoprotein-cholesterol.

The underuse of HMG-CoA reductase inhibitors in eligible patients has important implications for mortality, morbidity and cost, given the enormous economic burden associated with CAD; direct healthcare costs, estimated at $US16–53 billion (2000 values) in the US and £1.6 billion (1996 values) in the UK alone, are largely driven by inpatient care. Hospitalization costs are reduced by treatment with HMG-CoA reductase inhibitors, particularly in high-risk groups such as patients with CAD and diabetes mellitus in whom net cost savings may be achieved.

HMG-CoA reductase inhibitors are underused because of institutional factors and clinician and patient factors. Also, the vast number of patients eligible for treatment means that the use of HMG-CoA reductase inhibitors is undoubtedly limited by budgetary considerations. Secondary prevention in CAD using HMG-CoA reductase inhibitors is certainly cost effective. Primary prevention with HMG-CoA reductase inhibitors is also cost effective in many patients, depending upon CAD risk and drug dosage. As new, more powerful, HMG-CoA reductase inhibitors come to market, and the established HMG-CoA reductase inhibitors come off patent, the identification of the most cost-effective therapy becomes increasingly complex. Research in to the relative cost effectiveness of alternative HMG-CoA reductase inhibitors, taking full account of the institutional, clinician and patient barriers to uptake should be undertaken to identify the most appropriate role for the new therapies.

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Acknowledgements

This review was undertaken with financial support from AstraZeneca. Research support was provided by Dr Ian Wright of Adelphi Communications. Very helpful comments were provided by three anonymous referees.

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    Chris McCabe

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McCabe, C. Cost Effectiveness of HMG-CoA Reductase Inhibitors in the Management of Coronary Artery Disease. Am J Cardiovasc Drugs 3, 179–191 (2003). https://doi.org/10.2165/00129784-200303030-00004

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Keywords

  • Coronary Artery Disease
  • National Cholesterol Education Program
  • Coronary Artery Disease Risk
  • Coronary Artery Disease Prevention
  • Established Coronary Artery Disease