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Centre for Evidence-
Based Medicine

Coronary Heart Disease: Simvastatin is cost effective in men and women at high risk of coronary events

Purchasing Bottom Line

Simvastatin is cost effective in men and women at high risk of cardiac events compared with other treatments for common conditions.


Johannesson M, Jönsson B, Kjekshus J, Olsson AG et al. Cost effectiveness of simvastatin treatment to lower cholesterol levels in patients with coronary heart disease. New England Journal of Medicine. 1997;336:332-336.

Purchasing Question

How much does simvastatin cost per year of life gained?

Search Terms

MEDLINE search using cost effectiveness, simvastatin, coronary heart disease

The Study

A cost effectiveness analysis, based upon the effectiveness data from the Scandinavian Simvastatin Survival (4S) Study, using a Markov* incremental cost model to assess the costs per year of life gained using simvastatin in people at high risk of cardiac events (men and women 35 to 70 years with total cholesterol levels of 213 to 309 mg/dl with a history of angina pectoris or acute myocardial infarction). Direct and indirect costs were calculated from Swedish data at the 1995 exchange rate with the $US. A 5% discount rate was used to calculate costs of future years of life gained. Sensitivity analysis was conducted taking into account differences in risk reduction of cardiac event; risk of mortality after event; inclusion of health costs in gained years; morbidity associated costs; intervention costs with follow up, screening, and US drug prices, and discount rates of 0%, 5%, and 10% per year.

* Markov model: A model of a sequence of events, in which the probability of an event occurring in the future depends upon a the occurrence of a (specified) preceding event.

The Evidence

Total cholesterol before treatment (mg/dl) Age 35 Age 59 Age 70
men women men women men women
Analysis of direct costs ($US)
213 11400 27400 7000 16400 6200 13300
261 8800 18800 5500 10300 4700 8500
309 6700 13200 4200 7100 3800 6200
Analysis of direct and indirect costs
213 savings savings 2100 8600 6200 13300
261 savings savings 1600 4900 4700 8500
309 savings savings 2100 3200 3800 6200


  1. The main results (tabled above) do not take into account costs of extra years gained from patients not dying, nor quality of life effects, so they do not compare the cost effectiveness of simvastatin versus no or alternative treatment.
  2. Decision makers in other countries would need to consider their own costs compared to those outlined in this study (outlined in Table 2).
  3. The results apply only to people at high risk of cardiac events, not the general population. The lower cost effectiveness in women is due predominantly to their lower risk of events than men from 35 years.

Appraised By

Anna Donald and Sam Vincent March 1999.

Expiry Date

March 2001