Pfizer has criticised new NICE guidance on statins which says prescribers should choose the cheapest available because there is no evidence that any one is superior in preventing cardiovascular disease.

The manufacturer of Lipitor (atorvastatin), the biggest selling statin in the UK and worldwide, Pfizer says NICE has overlooked key data on safety and effectiveness which means not all statins are the same.

Pfizer can point to a vast amount of data which proves Lipitor can cut mortality from cardiovascular disease - data which most of its rival patented drugs cannot match.

But simvastatin (formerly Merck Sharp & Dohme's Zocor) does have a comparable level of data on mortality, and is now available generically at much lower cost than Lipitor.

One head-to-head trial between atorvastatin and simvastatin found no statistical differences in the two outcomes - reported heart attacks and stroke.

NICE's conclusion to its preliminary appraisal document on the statin class states: "It was not possible to differentiate between the statins on the basis of their ability to prevent coronary events.

The Committee said it was also aware of large variations in cost and potential for further price changes. It concluded: "When the decision has been made to prescribe a statin and different types of statin are considered appropriate, therapy should be initiated with the drug with the lowest acquisition cost (taking into account required daily dose and product price per dose)". NICE did however recommend extending the use of statins to prevent a first heart attack in under 75s with a 20% or greater risk of developing CHD.

Responding to the guidance Dr Kate Lloyd, Pfizer medical director said: "Clinicians have long known the benefit of statins in preventing heart attacks and strokes, and while this appraisal confirms the cost-effectiveness of this important class of treatments, it fails to recognise that each statin is unique.

"Pfizer hopes that NICE will reconsider the implications of this guidance and looks forward to further detailed dialogue with NICE before the final report later this year."

NICE estimates that expanded prescribing in primary prevention would cost the NHS an extra £113 to £170 million, representing 1.5 million people.

It based its estimation on 50% of the new prescriptions being generic simvastatin at 20mg/day and 50% at 40mg/day.

pharmafocus@wiley.co.uk