Statin treatment for primary prevention of vascular disease: whom to treat? Cost-effectiveness analysis

Dear Sir,

We thank Drs Vos and Smith for their interest in our study.

Dr Vos
questions the assumptions made in our analysis, in particular regarding
mortality rate and costs of statin treatment. As stated in our methods, we
assigned survivors of a first myocardial infarction or stroke a two-fold
increased risk for death. Thus, we did not assume a reduced post event
mortality rate. With regard to costs of statin treatment, these costs
include those incurred by the drug, laboratory tests, doctors' visits, and
pharmacists' fee. This implies that our conclusion is justified: statins
ARE cost-effective for high risk primary prevention populations, but
seemed not to be cost-effective for low risk prevention populations.

Dr Smith questions the cost-effectiveness of statins with alternative cost
assumptions. The suggested alternative assumptions will probably lead to
more favourable cost-effectiveness. However, until now there is not enough
evidence to justify these alternative assumptions. Our cost-effectiveness
analysis is based on how statin treatment should be provided according to
current cardiovascular risk management guidelines in The Netherlands.

Dr Jacoba P Greving, senior research fellow in clinical epidemiology;

Prof Dr Frank LJ Visseren, internist and professor of vascular medicine;

Dr G Ardine de Wit, associate professor of health technology assessment;

Prof Dr Ale Algra, professor of clinical
epidemiology