Cholesterol Management and Long-Term Cardiovascular Disease Prevention

Peter Salgo, MD: Let me put it to you this way. I could tell you, and these guys are suggesting this, that by taking the LDL cholesterol, with these new agents, down to 20 mg/dL, heart disease is going to plummet, there will be no CABGs (coronary artery bypass graft) surgeries, or very few, and there will be no stents and no loss of work days. But it’s going to cost you a little bit more per dose.

Gary L. Johnson, MD, MBA: Two points: when you say that it’s going to plummet, lipids is an important factor, but not the only factor in cardiovascular events. It will make a reduction in cardiovascular events and will cause a reduction in cost, but on the other side, if paying for these very expensive drugs that are more than $1000 a month, the savings that you would accrue from fewer cardiovascular events will, in no way, make up for that.

Peter Salgo, MD: How much does a CABG cost?

Gary L. Johnson, MD, MBA: I don’t know.

Seth J. Baum, MD: What is the value of a life?

Peter Salgo, MD: How much does a CABG cost?

Howard Weintraub, MD: Hundreds of thousands of dollars.

Peter Salgo, MD: These guys are forced to deal with real numbers, not how much a human life is worth.

Howard Weintraub, MD: A single stent is 50 grand.

Peter Salgo, MD: Fifty grand?

Howard Weintraub, MD: Right.

Peter Salgo, MD: That’s at $1000 a month; $12,000 a year, at 3 to 4 years’ worth.

Howard Weintraub, MD: Then you’re going to give them the $1000/month one because you’re going to stent 1 artery and there will be 2 arteries that are contentions to do it again in a year-and-a-half. So, they’ll be back.

Peter Salgo, MD: All I’m asking is, can’t you just frontload this? You suck it up, you pay the money, and you’re going to get it back on the other end?

Gary L. Johnson, MD, MBA: I think we do that. I think all insurance companies, and I can say this universally, do pay for preventive care. It’s mandated.

Howard Weintraub, MD: Define “preventive care.”

Howard Weintraub, MD: Preventive care, from what I’ve seen, is a mammogram and a flu shot.

Seth J. Baum, MD: And an annual physical.

Howard Weintraub, MD: And those are important, but for many patients, their insurance won’t pay for a second cholesterol test during the year. I’ve seen it.

Gary L. Johnson, MD, MBA: Again, it’s very difficult to talk about individual insurance companies. Obviously, the companies that you have dealt with are clearly different than what my experience has been.

Howard Weintraub, MD: I’m looking at you, but not accusing you.

Gary L. Johnson, MD, MBA: You’re right. I understand.

Howard Weintraub, MD: Doctors don’t sit here with a score card saying, “If you get everybody on your insurance, we’re going to have an easy day.” What we do is we sort of behave to the lowest denominator, and we get anxious about these things.