The Costs Of Cutting Cholesterol

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At the New England Journal of Medicine's Web site:

A major study coming out of the American Heart Association meeting in New Orleans this week suggests that many people who have no signs of heart disease should be taking statin drugs, which lower cholesterol and may have other beneficial effects.

But the brand-name versions of these drugs are very expensive.

Treating all Americans who meet the study's criteria could add $8.9 billion a year to the nation's health care bill, according to Dr. Jon Keevil and colleagues at the University of Wisconsin School of Medicine and Public Health.

That's based on an estimate that 7.4 million more adults would start taking a brand-name statin such as Crestor. The study found a positive effect for Crestor in healthy men over 50 and women over 60 who had no evidence of cardiovascular disease or diabetes, and whose blood tests were normal.

According to study co-author James H. Stein, a "back of the napkin" calculation puts the cost of preventing a cardiovascular "event" using a brand-name statin like Crestor at $203,000 per event per year. (Such events include heart attacks, strokes and other conditions affecting the heart and the blood vessels, and deaths.)

If you look just at preventing deaths, it would cost $480,000 to save a life with a brand-name statin, Stein says.

The average heart attack costs about $52,202 for hospital care, according to the Agency for Healthcare Research and Quality.

Some doctors believe that the benefits seen with Crestor might apply to statins that have already gone generic, like simvastatin (aka Zocor) or pravastatin (aka Pravachol).

If that's the case, it could save people — and society — a lot of money, Stein says.

Simvastatin and pravastatin are available for $5 a month or less at many pharmacies. Treating 7.4 million adults with a $5 generic would cost a mere $443 million per year, Stein estimates. A cardiovascular event could be prevented for a cost of $10,200 a year. Preventing a death would cost $24,000.

Keevil's study, also presented at the AHA meeting, predicts that there would be 43,526 fewer cardiovascular events each year and 18,443 fewer deaths if the 7.4 million adults were put on a regimen of 20 milligrams of Crestor a day.

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