November 11, 2008

Crestor Would Save Lives — at $500,000 Each

By Steve Sternberg

NEW ORLEANS -- Using Crestor to prevent heart attacks and save lives in apparently healthy people would add nearly $10 billion a year to the nation's medical bill, according to calculations released Monday.

Crestor's high cost was just one of many concerns that emerged as doctors began to grapple with the implications of a landmark study released Sunday. The study, called JUPITER, showed that using the potent cholesterol-lowering statin to treat people with normal cholesterol cut in half their risks of heart attacks, strokes and premature death.

"JUPITER's a tour de force," says Donald Lloyd-Jones of Northwestern University. But he adds that it has prompted doctors to question the best ways to measure heart-disease risk, when to begin statins and how to get people to adopt lifestyle changes that are the cheapest and best ways to stave off heart disease.

The best measure of their uncertainty might be a tongue-in-cheek question asked during the session at an American Heart Association meeting here: "Should we put statins in the water supply?"

The study, involving 18,000 patients, supplied powerful evidence that statins save lives by driving down blood cholesterol and cooling inflamed arteries, as measured by high blood levels of C-reactive protein.

In the past, statins were used mainly to treat patients with heart disease or high cholesterol and other well-established risks. JUPITER proved it may not pay to wait. The trouble is that Crestor, the trade name for rosuvastatin, is so expensive, says James Stein of the University of Wisconsin School of Medicine and Public Health.

About 7 million people nationwide would qualify for treatment under the JUPITER protocol, at a cost of about $116 a month -- or $9.7 billion a year, Stein says. For that price, the drug would prevent, taken together, about 28,000 heart attacks, strokes and cardiovascular deaths each year.

The cost of saving one life, he says, would total about $557,000. Using a generic statin would be much more cost-effective. Stein calculates that, at $5 a month, generics would cost $420 million, or $24,000 to save a life.

And that doesn't include the cost of C-reactive protein tests, Stein says.

Researchers debated whether the tests should be routine, given that many study patients did have other risk factors, including obesity and smoking, although their cholesterol was low.

Lloyd-Jones said the current method of assessing heart risk, based on 10-year estimates derived from the Framingham Heart Study, fails to give young people an accurate picture of their lifetime risk. "Between 20 and 40 is when the plaques in your arteries are being formed," he says. "If plaques are there, eventually they're going to get you." (c) Copyright 2008 USA TODAY, a division of Gannett Co. Inc. <>