Cost effectiveness of statin therapy for the primary prevention of major coronary events in individuals with type 2 diabetes

Abstract

OBJECTIVE - To assess the cost and cost effectiveness of hydroxymethylglutaryl (HMG)-CoA reductase inhibitor (statin) therapy for the primary prevention of major coronary events in the U.S. population with diabetes and LDL cholesterol levels ≥100 mg/dl, especially in the population with LDL cholesterol levels 100-129 mg/dl. RESEARCH DESIGN AND METHODS - Analyses were performed using population estimates from National Health and Nutrition Examination Survey (NHANES)-III, cost estimates from a health system perspective, statin LDL-lowering effectiveness from pivotal clinical trials, and treatment effectiveness from the diabetic subgroup analysis of the Heart Protection Study. RESULTS - There are ∼8.2 million Americans with diabetes, LDL cholesterol levels ≥100 mg/dl, and no clinical evidence of cardiovascular disease. Each year, statin therapy could prevent ∼71,000 major coronary events in this population. In the subgroup with LDL cholesterol levels 100-129 mg/dl, the annual cost of statin treatment ranges from $600 to $1,000 per subject. In the population with LDL cholesterol levels ≥130 mg/dl, the annual cost ranges from $700 to $2,100. Annual incremental cost per subject, defined as the cost of statin treatment plus the cost of major coronary events with statin treatment minus the cost of major coronary events without statin treatment, ranges from $480 to $950 in the subgroup with LDL cholesterol levels 100-129 mg/dl and from $590 to $1,920 in the population with LDL cholesterol levels ≥130 mg/dl. CONCLUSIONS - Statin therapy for the primary prevention of major coronary events in subjects with type 2 diabetes and LDL cholesterol levels 100-129 mg/dl is affordable and cost effective relative to statin therapy in subjects with higher LDL cholesterol levels.