How cost-effective is the treatment of dyslipidemia in patients with diabetes but without cardiovascular disease?

OBJECTIVE - Epidemiological studies have shown that the risk of myocardial infarction (MI) in diabetic patients without cardiovascular disease (CVD) i s comparable to the risk of MI in patients with CVD. We used a validated Ma rkov model to compare the long-term costs and benefits of treating dyslipid emia in diabetic patients without CVD versus treating CVD patients without diabetes in the U.S. The generalizability and robustness of these results w ere also compared across six other countries (Canada, France, Germany, Ital y, Spain, and the U.K.). RESEARCH DESIGN AND METHODS - With use of the Cardiovascular Disease Life E xpectancy Model, cost effectiveness simulations of simvastatin treatment we re performed for men and women who were 40-70 years of age and had dyslipid emia. We forecast the long-term risk reduction in CVD events after treatmen t. On the basis of the Scandinavian Simvastatin Survival Study results, we assumed a 35% reduction in LDI cholesterol and an 8% rise in HDL cholestero l. RESULTS - In the U.S., treatment with simvastatin for CVD patients without diabetes was cost-effective, with estimates ranging from $8,799 to $21,628 per year of life saved (YOLS). Among diabetic individuals without CVD, lipi d therapy also appeared to be cost-effective, with estimates ranging from $ 5,063 to $23,792 per YOLS. In the other countries studied, the cost effecti veness of treating diabetes in the absence of CVD was comparable to the cos t effectiveness of treating CVD in the absence of diabetes. CONCLUSIONS - Among diabetic men and women who do not have CVD, lipid thera py is likely to be as effective and cost-effective as treating nondiabetic individuals with CVD.