Issue 163 Item 6 Statins Cost-Effective for Diabetics With Mildly Elevated LDL

A cost saving of 7.4 Billion dollars could be obtained if statin therapy is used for ype-2 diabetes and mildly elevated (100-129 mg/dL) LDL cholesterol, but no clinical evidence cardiovascular disease, researchers report in the June issue of Diabetes Care.

To assess the economics of statin use in this patient population, Dr. Michael Brandle from the University of Michigan in Ann Arbor and colleagues used population estimates from NHANES III, cost estimates from the perspective of a large health system, and statin effectiveness data from pivotal clinical trials.

They found that the cost of statin therapy per patient per year is generally lower in diabetics with mildly elevated LDL ($600-$1,000) compared with LDL in the 130 mg/dL+ range ($700 to $2,100), depending on the statin prescribed.

From a health system perspective, treating these patients with statins would cost between $1.8 and $3.2 billion each year — the lower figure if the least expensive statin were always used. This is less than half the $6.5 to $10.6 billion annual price tag for treating all subjects with LDL levels of 130 mg/dL or more, the authors note.
Dr. Brandle’s team also reports that prescribing statin therapy in diabetics with no heart disease and LDL levels of 100 mg/dL or greater could prevent roughly 71,000 major coronary events annually, 18% (13,000) of these in the population with LDL between 100-129 mg/dL.

Study co-author Dr. William H. Herman of Michigan told Reuters Health that "treating patients with diabetes and mildly elevated cholesterol levels to prevent heart attacks is as cost-effective as treating diabetic patients with higher cholesterol levels and can be done without substantially increasing total healthcare costs if the cheapest effective cholesterol lowering medicine is always used."
The American Diabetes Association does not explicitly recommend pharmacologic therapy for this patient population, but several observational and large randomized studies suggest a benefit to aggressive LDL lowering in these individuals. For example, in the UK Prospective Diabetes Study, a 39-mg/dL (1-mmol/l) drop in LDL was associated with a 36% reduction in the risk of coronary heart disease.

Diabetes Care 2003;26:1796-1801.