Editor—Although the savings identified by Moon and Bogle look impressive,1 and the price of simvastatin may look cheap; the authors have overstated the cost of simvastatin to the NHS by a factor of 4, and the future cost, probably by a factor of 8 and maybe 40.
The market price for simvastatin 10 mg is 29p per pack, 20 mg is 39p/pack, and 40 mg is 96p/pack.2 The difference with the tariff price (£1.81, £2.34, and £4.233) is pharmacy profit. Profit on category M products helps fund pharmaceutical services. Increased prescribing of simvastatin will not result in increased pharmacy profits as the price of this and other category M products is adjusted quarterly to maintain a predetermined overall level of profit. The real cost to the NHS hence is the market cost, not the tariff price.
Simvastatin 40 mg has been in comparative short supply in the market owing to its popularity after the heart protection study and recent reductions in tariff price that have now made it an attractive switch for cash strapped primary care trusts. Its longer term price should be twice the price difference between the 10 mg and 20 mg tablets above the market price of the 20 mg tablet; or about 56p/pack. Given the volume, this is probably still an overestimate and a price in line with bendroflumethiazide (2.5 mg, 9p/pack) or atenolol (50 mg, 9p/pack) is likely.2
Figure 1.
Credit: GEOFF KIDD/SPL
The National Institute for Health and Clinical Excellence (NICE) has also failed to recognise this in its cost analysis. NICE also underestimates the savings in hospital costs, which are clearly out of line with the savings seen in the economic analysis of the heart protection study.4
Competing interests: None declared.
References
- 1.Moon JC, Bogle RG. Switching statins. BMJ 2006;332: 1344-5. (10 June.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.www.drugtariff.com (accessed 9 Jun 2006).
- 3.www.ppa.org.uk (accessed 9 Jun 2006).
- 4.Heart Protection Study Collaborative Group. Cost-effectiveness of simvastatin in people at different levels of vascular disease risk: economic analysis of a randomised trial in 20,536 individuals. Lancet 2005;365: 1779-85. [DOI] [PubMed] [Google Scholar]