Cost effectiveness of treating high-risk individuals aged 45-65 years withstatins in Germany for primary and secondary prevention of coronary heart disease from the perspective of the social security system

Aim Guidelines on primary and secondary prevention of coronary heart diseas e (CHD) in Europe are intensively debated because of the potential financia l impact of treating all patients at elevated CHD risk on the budget for ph armaceuticals. In the present study we estimated the cost effectiveness of treating the largest possible number of patients with demonstrable evidence for treatment benefit for cholesterol-lowering drugs in the age group 45-6 5 years from the perspective of the social security system. Methods The analysis is based on a model which approximates the discounted lifetime costs of all patients who presented themselves in 1996 to a German hospital for either primary or secondary events of CHD or who died from CH D in that year. The costs of this cohort in 1996 and up to their projected end of life was estimated and included all direct and indirect costs (disco unt rate: 4%). Data for direct costs were generated from the Federal Bureau of Statistics, sickness funds, retirement funds, hospital admission data s ources, primary care panel physician data and other sources. Gender and age -specific unemployment rates were considered in calculating indirect costs. Additionally, the effects on revenues and expenses for sickness funds and other parts of the social security system were estimated. Thus the model al lows cost-effectiveness analysis from the perspective of society as a whole as well as from the perspective of the social security system or parts of the system, including the effects on retirement payments. The model was the n used to approximate the effects on costs and outcomes of a prevention pro gramme with statins for cholesterol lowering could have in the subgroup of those aged 45-65 years. Discounted direct costs for the treatment of all pr evalent cases of CHD in Germany in 1996 are approximately US$22 billion. In direct costs total US$40 billion (societal perspective). The cost effective ness of treating all patients within the age group 45-65 years with a total cholesterol level of at least 240 mg. dl(-1) for primary or secondary prev ention, irrespective of any further risk factors from the perspective of th e social security system varied between approximately US$40 800 and US$74 7 00 per life-year saved when considering from lowest to average market price s of available statins at median dose. The programme would add prevention c osts of US$2.67 billion per year to the social security system. It would sa ve 270 161 life-years, or about 3602 lives at an average life expectancy of 75 years. Conclusion Even a liberal policy of primary and secondary prevention can be reasonably cost effective in the age group 45-65 years for both genders fr om the perspective of the social security system. The cost effectiveness is highly sensitive to the price of the prescribed statins.