Medical Costs per QALY of Statins Based on Swiss Medical Board Assumptions

Aims: The Swiss Medical Board (SMB) recommends statins in primary care, if risk for coronary death or noncoronary vascular death (SCORE) is above 7.5% in 10 years, because cost per quality-adjusted life years (cost/QALY) is CHF 210,279 over 5 years. Rationale and effect require further examination. Methods: The SMB cost-efficiency model is applied to 10 rather than 5 years, and for different risk levels for vascular events. These SMB recommendations were studied in a population of 5144 healthy subjects from Germany and Switzerland, in whom the prevalence of advanced carotid atherosclerosis (total plaque area ≥80 mm²: TPA80) was assessed. Results: Cost/QALY was CHF 210,279 in 5 years for SCORE risk of 0.91%. Cost/QALY was CHF 2089 in 10 years for an SCORE risk of 7.5% and was CHF 62,057 for a SCORE risk of 2.5%. At SCORE risk of ≥5% and ≥7.5%, respectively, 86% and 96% of Swiss and 89% and 96% of German subjects aged 40–65 years with TPA80, would be excluded from statin intervention. Conclusion: Cost/QALY of statins is acceptable at a SCORE below 5%. The SMB recommendation to use statins only above the 7.5% SCORE risk threshold cannot be derived from the SMB model. The atherosclerotic burden in primary care is highly prevalent in patients with a SCORE below 5%. Adjustments to lower contemporary risk thresholds for statins should be discussed.