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Letters to the Editor
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Statins
Debate on spending needed
From Dr B. Curwain, MRPharmS
Your headline “Routine
use of statins in all type 2 diabetes patients is a step too far” (PJ, 28 August, p280) hits the nail
on the head.
What the CARDS trial showed is that if you treat 1,000 people with diabetes
for four years with a statin, then 37 major cardiovascular vents will
be prevented.
Using the trial drug (atorvastatin), this would cost £800,000 which
means that each event prevented costs £21,600. It also means that
963 of the 1,000 patients would have exactly the same outcome (either
they would, or would not, have a major cardiovascular event) as if they
had not received the drug.
The thing about large clinical trials is that they can detect small,
but measurable, benefits. Whether or not trial results should be extrapolated
to general practice where patients frequently fail to take medicines
in the prescribed manner is another question.
The sort of debate that the NHS needs to have with the public, and with
its political masters, is around whether it might be better to spend
the £800,000 on something else, such as smoking cessation or the
control of obesity. Equally you could give all the patients simvastatin
20mg daily,
which would now cost only £267,000.
Brian Curwain
Chief pharmacist and head of primary care
New Forest Primary Care Trust
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The
Pharmaceutical Journal