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?From the Stockl presentation of these data at AHA, today:
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
1 comment:
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....
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