Will insurers join the 4S club?
Will insurers join the 4S club?
Costs drop when diabetics take simvastatin
The data from the Scandinavian Simvastatin Survival Study (4S) hold good news for diabetic patients who have high cholesterol. After analyzing the 4S results, a team of Michigan researchers report that diabetics who took the cholesterol-lowering therapy generated short-term cost savings and long-term heath benefits, both of which should help convince insurers to pick up the bill.
Simvastatin is costly, about $6,000 per patient over the five-year study. But the numbers show the results are worth the initial cost, says William H. Herman, MD, MPH, an endocrinologist and professor of medicine at the University of Michi-gan in Ann Arbor. "Most interventions are more cost-effective when applied in higher risk patients, so by being truly aggressive, you can prevent more events and save money, too," he says.
"This paper adds major financial reasons for putting patients on simvastatin in addition to the obvious medical benefits." In the short term, Herman explains, few drugs of any type have had these kind of impressive results in terms of health benefits and cost savings.
Earlier analysis of the 4S results showed diabetic patients with coronary heart disease treated with simvastatin had 36% lower low-density lipoprotein cholesterol levels than placebo-treated subjects and a 43% lower risk of all-cause mortality. The new numbers continue to look good. Here is what Herman’s team found:
- 37% reduction in revascularizations;
- 40% reduction in cardiovascular disease-related hospitalizations;
- 26% reduction in the frequency of all-cause hospitalizations;
- 34% reduction in total length of hospital stays;
- reduction in direct costs over the duration of the five-year follow-up of $3,872 per patient, which offset approximately 60% of the cost of the drug.
Nondiabetic patients with impaired glucose tolerance also benefited in a big way. They reduced their hospitalization costs by $4,478, which offset 74% of the drug’s cost. According to the study, the net savings to insurers when a diabetic takes simvastatin are $1,801.
Insurers should take notice of these results, according to Paul Jellinger, MD, an endocrinologist in private practice in Hollywood, FL, and president-elect of the American Academy of Clinical Endocrinologists. "We can usually get an approval for a statin drug, but because of the cost, frequently managed care will only approve the weaker statins," says Jellinger.
That means patients have to go through a three- or four-month course of the weaker statin, only to have unsatisfactory results that finally lead to approval for the stronger drug, he explains. "It’s terrible for the patient and wastes three or four months of his life."
Herman’s conclusions are "very valid," Jellinger says. "We’ve been treating our patients very aggressively with the statins, and we know they result in fewer events and lower costs. This just puts it in black and white."
[For more information, contact William Herman at (734) 936-8279 and Paul Jellinger at (954) 963-7100.]
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