From 4S to IDEAL: the health economics of the statin trials.

The introduction of statins led to much interest in their health economic aspects as they were initially perceived as efficacious but potentially expensive. Consequently, abundant literature exists examining the cost effectiveness of various statins, with analyses estimating the costs of preventing a single cardiovascular event using trial-based data, as well as long-term modelling studies using standardized outcomes such as cost per life-years gained or cost per quality-adjusted life-years. Economic evaluations based on clinical trials with hard endpoints indicate that the improved care associated with statin therapy came at a reasonable price in most risk groups. Variations between study results can largely be explained by differences in drug prices and absolute risk in the studied populations. This holds true for both within-trial analyses and modelling studies. The introduction of generic statins has led to sharp price reductions. Consequently, statin use today would be associated with greater cost savings in the indications that were first studied in clinical trials. New therapies entering the field must now compare favourably with statin therapy, whereas earlier a comparison versus placebo would have been sufficient to demonstrate cost effectiveness.