Cost-benefit analysis of an evidence-based secondary prevention of coronary heart diseases by statins. An analysis for Germany from a social security perspective

Abstract

Lowering of the cholesterol level is of central importance in the prevention of coronary heart disease. Although the clinical benefits of treatment with statins have been shown in numerous studies, economic considerations are also being taken increasingly into account for the decision process about health care benefits. With this background, a cost-benefit analysis was carried out for statin treatment. Based on a cost analysis for coronary heart disease carried out by the authors from a social security standpoint, the net prevention costs for secondary prevention in Germany were assessed. The ICD-9 codes 410-414 were assigned to coronary heart disease. In addition to the direct costs of treatment for coronary heart disease, loss of premiums for social security, savings on old age pensions, related pension claims and wage compensations over a time period of 10 years were also quantified in the cost analysis. Furthermore, prevention through medication for the 45- to 64-year-old coronary heart disease patients was considered. Costs for prevention were assessed on the basis of the mean dosages of all medications on the market according to the Rote Liste (German Formulary). A risk reduction of 30% was assumed and numerous univariate sensitivity analyses were carried out. Depending on which parameters were varied, there were pronounced differences in the results. The most favourable cost-benefit relation was achieved for the preventive measures in 400,000 patients with net prevention costs of 1.08 billion DM (2.16 billion DM for 800,000 patients) for a duration of medical preventive care of 5 years. The highest net prevention costs of 3.47 billion DM for 400,000 coronary heart disease patients (or 6.93 billion DM for 800,000 patients) resulted when maximum prices for statins were assumed. In the setting taken as base analysis, approximately 25% of the prevention costs are accounted for by cost saving through prevention. The transfer of clinical study results into clinical practice is associated with uncertainties which necessitate comprehensive sensitivity analyses. The costs of coronary heart disease were shown to be highly sensitive to the cost-benefit relationship. Although from an overall social security perspective, the direct costs of treatment and the loss of premiums were balanced by reduced expenditure (pension savings), coronary heart disease does lead to a financial burden on the social security. This financial burden is decreased by prevention of coronary heart disease. Part of the costs of statin therapy can be covered in every situation by cost savings through the avoidance of coronary heart disease. Even complex simulation models, that uses realistic assumptions, could only determine the costs of an evidence-based secondary prevention of coronary heart disease unprecisely, because the worst case and the best case vary with the factor 7.