Here’s a great comment, just now posted — about today’s UnitedHealth study presentation at AHA, in Orlando; it deserves “front-page” exposure:
. . . .Let’s do a little “Number-Needed-to-Treat” (NNT) and economic analysis, shall we?
Vytorin (simvastatin/ezetimibe) 96 events/9983 patients over 1.06 years of follow-up = 0.91%/year event rate
Atorvastatin 115 events/9983 patients over 1.16 years of follow-up = 0.99%/year event rate
Simva 124 events/9983 patients over 1.08 years of follow-up = 1.15%/year event rate
NNT = 1/absolute risk difference
Vytorin (simvastatin/ezetimibe) vs atorvastatin NNT = 1,250. This means you’d have to treat 1250 patients to prevent one event with Vytorin compared to atorvastatin.
Vytorin vs. simvastatin NNT =417
Assuming simvastatin costs 84 cents/day, atorvastatin $3.91/day, and Vytorin $3.74/day:
You’d have to spend $1.7 million to treat 1,250 patients for one year with Vytorin vs. atorvastatin to prevent one event, or spend $570 million for Vytorin vs. simvastatin, for one to prevent one event.
Since your average stroke/MI hospitalization costs about $30,000, we would have to spend way too much money to use Vytorin vs. either atorvastatin or dirt-cheap generic simvastatin. I’m no Peter Orszag, but I’m pretty sure there’s no way that will ever be viewed as cost-effective.
Don’t think we’ll be seeing any such analysis out of the Merck health outcomes shop any time soon.
— Anonymous, November 18, 2009 10:00 PM. . . .
~~~~~ Later ~~~~~
Now let’s get really re-dick-ulous! How about a pairing? . . .The UHC report with the known curvilinear relationship between LDL and events at the far low end of the LDL curve (think, IMPROVE-IT). Yes folks, the answer is the same. An LDL from 65 to 55 with a predicted 0.1% absolute risk difference in meaningful events (heart disease death, heart attack). That’s a NNT of. . . . 1000. Hmmm. . . there’s some symmetry there with the UHC findings. So, just go ahead boys and girls, keep those prescriptions coming. . . or, maybe with those odds, patients should save the money and play some powerball. There’s a better chance of meaningful return on investment, and it goes to a better cause. . . .
November 18, 2009 11:25 PM