Economics of lipid lowering in primary prevention: lessons from the West of Scotland Coronary Prevention Study.

On the basis of the clinical benefit and virtual absence of adverse effects observed with statin treatment in major primary and secondary prevention trials, a case could be made for considering statin therapy for all patients meeting the eligibility criteria for these trials. Establishing a risk threshold for statin treatment based on cost is an urgent item on the agenda of modern healthcare systems. An economic analysis using West of Scotland Coronary Prevention Study (WOSCOPS) findings indicates that statin treatment would have prevented 318 events per 10,000 patients in a population similar to that in WOSCOPS (average 1.5% annual risk of a cardiovascular event) at a discounted cost per life-year gained of 20,375 pounds($31,818). Application of current European treatment guidelines to consider treatment in patients with risk >2% per year would result in treatment of approximately 40% of the WOSCOPS population; discounted cost per life-year gained in this case would be 13,995 pounds($21,855). In Scotland, an annual risk threshold of > or = 3% for treatment has been adopted, corresponding to only 8% of the WOSCOPS population; the discounted cost per life-year gained is 9,680 pounds ($15,116). Reductions in drug cost, improved compliance, and use of more potent statins could alter cost efficiencies and encourage use of statins in a greater proportion of the primary prevention population that has been shown to benefit from such treatment.