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Letters to the Editor
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Statins
Is it a huge con?
From Mr F. M. Hickey, MRPharmS
Having spent a little time studying and reflecting on the availability
of over-the-counter statins I believe now that my prejudices have been
confirmed and that this is a huge con. By my estimate, carefully worked
out on the back of an envelope, it should cost somewhere between £50,000
and £100,000 of patients’ own money to prevent one coronary
event (probably a myocardial infarction) after five years of treatment
in the group highlighted.
So, if we take a town with 1,000 men and women in the category of moderate
risk of a first major coronary event in the next 10 years, what will
happen to them if they do nothing about it?
If they do nothing, 937 will be fine, but 63 will have had a heart attack
(or might even have died) after five years. However, once you have had
a heart attack you are considered at higher risk of something else going
wrong, so your GP will prescribe an effective dose of a statin (more
than 10mg simvastatin daily). If everyone who might benefit opts for
self-treatment and pays the full,
non-discounted price of OTC simvastatin (£12.99 per 28 days), then
perhaps 48 rather than 63 will have a heart attack or die after five
years, so 15 nasty cardiac surprises will have been avoided.1
This will have taken £844,000 of disposable income from the community
(approximately £844 per patient), assuming that they have all lasted
the course. Let us say that the cost to the NHS of an acute MI is £2,000
and involves eight days in hospital, so for the town’s residents
investing £845,000 of their own (post-tax) money, central government
might be hoping to save £30,000 and free 120 days of bed occupancy
over the same five-year period (loosely based on the NHS Reference Costs
2003 and National Tariff 2004, published by the Department of Health,
available at www.dh.gov.uk). Had the NHS funded this initiative the Treasury
would collect a certain amount from prescription charges, but that would
not come near to the cost of prescribing, dispensing and monitoring treatment.
Alternatively, you might argue that it will cost just over £56,000
of patients’ own money to prevent one cardiac event. Non-compliance
will be important (boredom will be a major factor) and I think it is
not unreasonable to suggest that the success rate will be as little as
half that being promoted, hence an upper estimate of £100,000 per
event avoided (probably a myocardial infarction) is, I think, not unreasonable.
(Central government financial savings and the impact on hospitals will
also be reduced by non-compliance.)
What about the alternatives? Exercise more, eat less and better. This
will either cost nothing or save you money and is likely to result in
an even smaller proportion of our group suffering a heart attack.
Give up the fags! A 20-a-day smoker will spend about £1,650 a year
on cigarettes, so that is £8,250 over five years.2 Perhaps 30 to
40 per cent of my target population are smokers, so this population group
might be spending £2.5m to £3.3m on their collective habit
over the five years. Patients will feel better, and be less likely to
suffer a whole barrel load of ill-health nasties. They will also be able
to enjoy a health-giving moderate intake of alcohol in a bar in Dublin,
in a country where legislators have had the courage to implement a real
public health initiative.
The down side of all these patients stopping smoking is that they will
pay less tax, which amounts to 80 per cent of the cost of a packet of
20. So maybe this explains why the Government is only partly interested
in tackling this addiction.
However, let us go back to the £844,000 that my community will
be encouraged to spend on medicines that will have a marginal effect
on health over a five-year period. What else could a community do with
that sort of money that would benefit its long-term health? Let us suppose
that the local school roll is also 1,000 and that the kids are in school
for 200 days a year. That sum would be equivalent to £0.85 towards
a healthy, nutritious meal (no chips) per child per day. This, I wager
will be of much greater benefit to the long-term health of our society
and will improve the quality of the raw material available to the national
football team.
Now, I have made some sweeping assumptions in this simplistic little
analysis, but none as unreasonable as assuming that a medicine given
at a dose that many consider to be subtherapeutic will have a clinical
benefit in the absence of clinical trials in the target population and
setting.
Findlay M. Hickey
Strathpeffer,
Ross-shire
References
1. Hird M. Over-the-counter simvastatin —
is it hype or a genuine hope for the future? The Pharmaceutical Journal
2004;273:156–60 (PDF 80K)
2. The economics of tobacco. London: Action on Smoking and Health;
2004.
Not convinced of value of Zocor Heart-Pro
From Mr M. Goldin, MRPharmS
My understanding is that POM-to-P switches are for drugs that are used
to treat relatively minor, self-limiting conditions that are characterised
by obvious symptoms. Now we have simvastatin making this giant leap for
mankind; but does it fit the case? I am not convinced that it does.
It is going to take a lot of persuasion to get me to sanction a sale
for this product. As an occasional locum pharmacist I have little contact
with drug companies or their representatives. If the makers of Zocor
Heart-Pro want to convince me so to do they are welcome to try. It is
going to take a lot of biros, paper clips and Post-it pads to get me
even to listen to their reasons in their effort to convince me to consider
recommending it.
Monty Goldin
London NW11 |
The
Pharmaceutical Journal