Rx Minute: Statins Value to Society & Risk Factors Linked to Alzheimer's
Statins Deliver Large Value to Society
A recent article published in Health Affairs highlights the remarkable impact of cholesterol-lowering drugs known as statins on the treatment of cardiovascular disease in the U.S. and around the world. Analyzing national survey data, the authors found that statin therapy reduced low-density lipoprotein cholesterol (LDL, so called “bad cholesterol”) levels by an average of 19% among individuals who used these drugs. This reduction in LDL levels translated into roughly 40,000 fewer deaths, 60,000 fewer hospitalizations for heart attacks, and 22,000 fewer hospitalizations for strokes in 2008 alone. From an economic perspective, these prevented hospitalizations are associated with gross savings of nearly $5 billion in the U.S.
The authors also estimated the aggregate social value, or “total surplus”, of the years of life saved in people taking statins between 1987 and 2008 to be $1.25 trillion. After subtracting spending on statins, consumers accrued a value of $947 billion, or about $35,000 per person taking statins. This translates into a roughly 4:1 benefit-to-cost ratio.
While the authors establish a strong rationale for the use of statins, they also lament the “potential underuse” of these medicines. They cite a number of studies that underscore the gap between the number of prescriptions written and reported patient use – otherwise known as nonadherence. Accordingly, they consider several potential policy changes that could encourage patient adherence to statin therapy. Options favored by the authors go beyond a focus on patient cost sharing, to also consider financial incentives for providers who successfully control the cholesterol of their patients through statin therapy, and the integration of medication adherence as a performance measure for emerging care models.
The authors conclude, “Policy makers should consider interventions at the patient and provider levels to encourage therapy for untreated patients with high cholesterol and greater adherence with the therapy after it is initiated.”
Two Independent Groups of Researchers Identify Risk Factor Linked to Alzheimer’s
Scientists from two independent research groups have identified a gene mutation that has been shown to increase an individual’s chance of developing Alzheimer’s disease. Both studies, published in the New England Journal of Medicine, found that people with a certain mutation on their TREM2 gene were three to five times more likely to get late-onset Alzheimer's – the most common form of the disease – than those without the mutation. This rate is comparable to the only other major known genetic risk factor for developing late-onset Alzheimer’s, a mutation in the ApoE4 gene, which increases a person’s risk by about 40%.
Alzheimer’s is the sixth leading cause of death in the U.S. and it affects over 5.4 million people and has cost the nation $200 billion in 2012 alone. As William Thies, Chief Medical and Scientific Officer of the Alzheimer’s Association notes, these studies are important because they point “very specifically to a potential metabolic pathway that you could intervene in to change the course of Alzheimer’s disease.”
The first study, conducted by researchers at the University College London among other universities, examined the DNA of 1,092 people with Alzheimer's and 1,107 people without the disease. The TREM2 mutation was found in approximately 2% of the group with the disease and only 0.45% of the control group. They then confirmed their results by testing a larger pool of about 6,700 Alzheimer's patients and 16,200 people without the disease.
The second study, conducted by the deCode Genetics team in Reykjavik, Iceland, studied the genome sequences of 2,261 Icelanders. The researchers found that people with the TREM2 mutation were three times more likely to develop Alzheimer's than those without it. They also found similar results by examining an additional 2,000 people in the U.S. and Europe. Furthermore, they found that people over 80 who had the mutation but did not have Alzheimer's had lower cognitive function than those without the mutation.
D.C. Grabowski, et al. “The Large Social Value Resulting From Use Of Statins Warrants Steps To Improve Adherence And Broaden Treatment,” Health Affairs, 31 (2012) 10, 2276-2285.
 Castillio, M. “Gene Mutation Identified as New Risk Factor for Alzheimer’s.” CBS News. November 15, 2012.
 Alzheimer’s Association. “Alzheimer’s Facts and Figures”. 2012. Available at: http://www.alz.org/alzheimers_disease_facts_and_figures.asp.
 Quote appearing in Kolata, G. “Alzheimer’s Tied to Mutation Harming Immune Response.” New York Times. November 14, 2012.
 Guerreiro R, et al. “TREM2 Variants in Alzheimer’s Disease”. New England Journal of Medicine. 2012. DOI: 10.1056 /NEJMoa1211851.
 Jonsson, T, et al. “Variant of TREM2 Associated with the Risk of Alzheimer's Disease”. New England Journal of Medicine. 2012. DOI: 10.1056/NEJMoa1211103.