SIMVASTATIN - A REAPPRAISAL OF ITS COST-EFFECTIVENESS IN DYSLIPIDEMIAAND CORONARY HEART-DISEASE

The Scandinavian Simvastatin Survival Study (4S) has confirmed the lin k between the cholesterol-reducing effects of simvastatin and improved survival in patients with hypercholesterolaemia and pre-existing coro nary heart disease (CHD). Pharmacoeconomic analyses of the 4S trial, u sing prospectively collected data for cost-generating events, demonstr ate that the cost per year of life saved for simvastatin in such patie nts falls within the range considered cost effective. Reductions in re source utilisation costs (numbers of hospitalisations and revascularis ation procedures) largely offset the acquisition cost of long term sim vastatin treatment in the US. Models of primary prevention incorporati ng epidemiological data to predict CHD events generally suffer from de ficiencies in the methods and assumptions used, and no firm conclusion s can be made at present regarding relative cost effectiveness of the drugs studied, including simvastatin. It is generally agreed that cost effectiveness will improve in patients with higher absolute risk of C HD. In summary, simvastatin has been shown in a major clinical trial a nd its companion economics analyses to reduce mortality and to be cost effective in patients with hypercholesterolaemia and existing CHD. As is the case for others of its class, its cost-effectiveness ratio in primary prevention remains to be ascertained. This issue aside, simvas tatin is a rational choice of cholesterol-lowering agent in secondary prevention whose use can be justified on an economic basis.