$638,000 to prevent one heart attack

Duff Wilson’s New York Times piece, “Risks Seen in Cholesterol Drug Use in Healthy People,” raises important questions about expanding the market for statins.

Especially strong was his breakdown of absolute risk reduction – and of cost impact. Here’s how he ended the piece:

“Critics said the claim of cutting heart disease risk in half — repeated in news reports nationwide — may have misled some doctors and consumers because the patients were so healthy that they had little risk to begin with.

The rate of heart attacks, for example, was 0.37 percent, or 68 patients out of 8,901 who took a sugar pill. Among the Crestor patients it was 0.17 percent, or 31 patients. That 55 percent relative difference between the two groups translates to only 0.2 percentage points in absolute terms — or 2 people out of 1,000.

Stated another way, 500 people would need to be treated with Crestor for a year to avoid one usually survivable heart attack. Stroke numbers were similar.

“That’s statistically significant but not clinically significant,” said Dr. Steven W. Seiden, a cardiologist in Rockville Centre, N.Y., who is one of many practicing cardiologists closely following the issue. At $3.50 a pill, the cost of prescribing Crestor to 500 people for a year would be $638,000 to prevent one heart attack.

Is it worth it? AstraZeneca and the F.D.A. have concluded it is.

Others disagree.

“The benefit is vanishingly small,” Dr. Seiden said. “It just turns a lot of healthy people into patients and commits them to a lifetime of medication.”

Winnie O’Kelley, deputy business editor of the Times, talked about the story in this video:

Comments

Linda posted on March 31, 2010 at 7:23 am

“The benefit is vanishingly small,” Dr. Seiden said. “It just turns a lot of healthy people into patients and commits them to a lifetime of medication.”
Wow! A doctor who is not a pimp for the pharmaceutical companies! Thank you, Dr. Seiden.

Alan posted on March 31, 2010 at 8:56 am

“The benefit is vanishingly small,” Dr. Seiden said. “It just turns a lot of healthy people into patients and commits them to a lifetime of medication.”
And then when you add in the side-effects and uncertainties discussed in the earlier part of the article and the “vanishingly small” benefits just vanish.

Paul Scott posted on March 31, 2010 at 8:03 pm

There is also the issue of whether the vanishingly small benefit provided by a drug like Crerstor has anything with its effects on the signal being addressed: cholesterol. It may have more to do with its effects on inflammation.

AMH posted on April 1, 2010 at 11:42 am

But there are generic statins out there that cost far less. Heck, even an asprin a day may provide similar benefits. To single out one expensive statin may not be telling the whole story.

Gary Schwitzer posted on April 1, 2010 at 2:50 pm

AMH:
Yes, there are cheaper generic statins.
But cost was not the main point of the NYT story, which was headlined,”Risks Seen in Cholesterol Drug Use in Healthy People.” Generic or brand name. Regardless the cost. The risk questions remain.
I chose to highlight cost in my blog post about the NYT story because doing the math on the number needed to treat and the cost impact therefrom is something that very few journalists capture. And I wanted to congratulate Duff Wilson for doing so.

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