Cost effectiveness of simvastatin treatment to lower cholesterol levels in patients with coronary heart disease. Scandinavian Simvastatin Survival Study Group

N Engl J Med. 1997 Jan 30;336(5):332-6. doi: 10.1056/NEJM199701303360503.


Background: The Scandinavian Simvastatin Survival Study (4S) showed that lowering cholesterol levels with simvastatin reduces mortality and morbidity in patients with angina pectoris or previous acute myocardial infarction. Before the widespread use of cholesterol-lowering drugs in such patients is recommended, its cost effectiveness should be demonstrated. We estimated the cost effectiveness of simvastatin treatment to lower cholesterol levels in relation to the age, sex, and cholesterol level before treatment of patients with coronary heart disease.

Methods: We estimated the cost per year of life gained with simvastatin therapy. To model the increased life expectancy, hazard functions from 4S were used. The costs studied included those of the intervention and the direct and indirect costs associated with morbidity from coronary causes. We prepared separate estimates for men and women at various ages (from 35 to 70 years) and total cholesterol levels before treatment (213 to 309 mg per deciliter).

Results: In the analysis limited to direct costs, the cost of each year of life gained ranged from $3,800 for 70-year-old men with 309 mg of cholesterol per deciliter to $27,400 for 35-year-old women with 213 mg of cholesterol per deciliter. When we included indirect costs, the results ranged from a savings in the youngest patients to a cost of $13,300 per year of life gained in 70-year-old women with 213 mg of cholesterol per deciliter.

Conclusions: In patients with coronary heart disease, simvastatin therapy is cost effective among both men and women at the ages and cholesterol levels studied.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Anticholesteremic Agents / economics*
  • Anticholesteremic Agents / therapeutic use
  • Cholesterol / blood
  • Clinical Trials as Topic
  • Coronary Disease / complications
  • Coronary Disease / drug therapy
  • Coronary Disease / economics*
  • Cost of Illness
  • Cost-Benefit Analysis
  • Female
  • Humans
  • Hypercholesterolemia / complications
  • Hypercholesterolemia / drug therapy*
  • Hypercholesterolemia / economics
  • Lovastatin / analogs & derivatives*
  • Lovastatin / economics
  • Lovastatin / therapeutic use
  • Male
  • Markov Chains
  • Middle Aged
  • Proportional Hazards Models
  • Sex Factors
  • Simvastatin
  • Value of Life


  • Anticholesteremic Agents
  • Cholesterol
  • Lovastatin
  • Simvastatin