OBJECTIVES: To conduct a systematic review of the literature on statin cost-effectiveness published up to April 2017.

METHODS: PubMed, Embase, and Cochrane Database of Systematic Reviews were searched to identify studies published in English between May 2007 and April 2017. Studies were selected if they conducted economic evaluation of statins as first- or second-line treatment for patients with hypercholesterolemia and/or at risk for cardiovascular disease. The outcome of interest was the cost-effectiveness results of statins reported in the studies. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two reviewers independently screened the title, abstract, and full-text articles. From the selected studies, data were extracted independently by two reviewers, and discrepancies were discussed with a third reviewer to reach consensus.

RESULTS: After removing duplicates and irrelevant articles, we identified a total of 283 articles; of these, 16 articles met our inclusion criteria. Nine studies compared statins with placebo or no treatment in their economic evaluations while seven studies evaluated cost-effectiveness between different statins. Statins (simvastatin, atorvastatin, and rosuvastatin) were considered to be cost-effective compared with placebo or no treatment in some countries. However, one study found pravastatin to be cost-ineffective compared with no treatment for primary prevention of coronary artery disease. Atorvastatin has consistently been reported as cost-effective compared with simvastatin. Mixed results were reported regarding the cost-effectiveness of rosuvastatin compared with atorvastatin: two studies found rosuvastatin could be economically more favorable than atorvastatin while one study reported the opposite findings.

CONCLUSIONS: Most statins were found to be cost-effective compared with placebo or no treatment. In addition, some statins were found economically favorable over other statins. Notably, these cost-effectiveness results should be interpreted with the consideration of the specific healthcare settings where statins were placed for their economic evaluations.