At the outset, I do not mean to cheapen human life, by reducing the entire analysis to dollars and. . . sense.
However, the PIs of the IMPROVE-IT study admit that the results suggest that one MI hospitalization event (for example) would likely be avoided over seven years, by putting 50 patients on Vytorin® (as opposed to simvastatin, or any statin as mono-threapy).
A month’s supply of Vytorin costs $200 at CVS — a statin costs $15 for that same month’s supply.
So. . . ($200 minus $15, or $185), times 12 months times 7 years, times 50 patients. . . equals $777,000 in additional drug costs.
It looks like the recent average US cost for an acute myocardial infarction hospital admission was around $30,000. So I guess Merck’s marketing thought is that — based on IMPROVE-IT’s data — we should pay an incremental $777,000 over seven years, to prevent one additional $30,000 hospital admission.
That math doesn’t really work, from a clinical stand-point.
Please tell me what I’m missing here. I must be mistaken. [But I bet I’m not.]
New Merck, Reviewed 
It makes perfect mathematical sense! But again who can argue with the fact that one can be on a Vytorin and can also be hit by a 18 wheeler!
The take home message is : what ever gets you to ~50mg/dl of LDL is the goal to maximize risk reduction. Do you think all statins, including Crestor used alone can get all patients to this level? Furthermore your numbers should factor that Zetia and Vytorin will be off patent in 2 years and making your economic comparisons irrelevant. Finally if you don’t think Vytorin is cost effective than you must also include Crestor which remains on patent and cost the same as Vytorin/Zetia
Thanks, Flem —
I guess I missed the part where anyone has agreed that acheiving 1 to 350 odds (of preventing one MI event) makes a compelling case.
Doubly true where the route is so darn expensive.
The IMPROVE-IT trial was head to head. Let’s stick to the actual results.
Diet and exercise — followed by statins, will be the first and second answers, for the foreseeable future.
And the statins may as well be generic right now. The generics are effective.
This blog focuses on Merck not AZ. Thus I must do. . . nothing, related to AZ’s statin.
Do stop back.
Namaste