With Prevention, The Sky's the Limit

Jupiter (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin), Astra-Zeneca's tour de force cholesterol-treatment trial, was released at the American Heart Association's national meeting yesterday and simultaneously published online yesterday. It's the talk of the town.

Especially in Boston.

That's where the study's lead investigator and the Brigham and Women's Hospital that holds patents on the c-reactive protein tests used to screen the 89,000-plus people for the 17,800 people enrolled in the trial are from. They're lovin' life right now.

Imagine inventing a test can be applied as a "screening test" on about 30 billion million people to find the 6 billionmillion or so people annually who would be benefitted by the prevention measure. Imagine making $1250 per year per person on the sale of your statin. Imagine that twenty five such individuals will have to be treated for five years with the statin to prevent one cardiovascular event.

Imagine.

This is not to say that the results of the trial are not impressive. To demonstrate a near 50 percent reduction in cardiovascular events in a carefully selected low-risk population for cardiovascular events is impressive. Really.

But at what price comes such preventative measures to our health care system?

If we assume that a 20-mg daily rosuvastatin (Crestor) tablet costs $107 per month to treat the average patient, and that twenty five patients have to be treated for five years to prevent one cardiovascular complication (and this does not include the annual liver function tests, the cholesterol tests, the C-reactive protein checks, etc), we begin to focus on an inevitable realization: that prevention is a remarkably expensive way to deal with our exploding health care costs.

For instance, if we assume that 25 people would have to be treated with Crestor for five years to prevent one cardiovacular event (as the study suggests), we can estimate the following back-of-the-envelope costs:

• Lipid level evaluation ($150 per test x 5 years) = $750
• C-reactive protein level $20 per year x 5 years = $100
• Annual liver function tests: $250 per test per year x 5 years = $1250
• Annual Crestor costs ($107 per month x 12 months per year x 5 years) = $6420
• Number of people needing to be treated over 5 years to prevent one cardiovascular event: 25
• TOTAL DOLLARS TO SAVE ONE CARDIOVASCULAR EVENT: $213,000

Applying these costs to the population that is thought to be at "risk" (some 6 to 10 billion million people), if every person were given this therapy, the cost to our health care system would implement this single prevention measure would amount to a whopping $51.12 trillion billion dollars over five years.*

Hey, if I owned stock in Astra Zeneca, I'd be "all in," too. But my simple calculations lead me to wonder if such prevention measures are the way to fix our current health care cost crisis.

I don't think so.

-Wes

*$213,000 per 25 people treated = $8,520 dollars per person treated over 5 years.
6 billion million people treated for five years x $8,520 dollars per person = $51,120,000,000.

Addendum 13:25 CST - Calculation corrections made. Thanks to Yoni and anony 12:18 who pointed out my error.