| Title: | Lifetime effects and cost-effectiveness of statin therapy for older people in the United Kingdom: a modelling study |
| Journal: | Heart |
| Published: | 10 Sep 2024 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/39256053/ |
| DOI: | https://doi.org/10.1136/heartjnl-2024-324052 |
| URL: | https://ora.ox.ac.uk/objects/uuid:060327c4-2fea-4e6f-9251-5653cfabb3c4/files/rm900nv770 |
Publication 13507
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Abstract
BACKGROUND: Cardiovascular disease (CVD) risk increases with age. Statins reduce cardiovascular risk but their effects are less certain at older ages. We assessed the long-term effects and cost-effectiveness of statin therapy for older people in the contemporary UK population using a recent meta-analysis of randomised evidence of statin effects in older people and a new validated CVD model.</p>
METHODS: The performance of the CVD microsimulation model, developed using the Cholesterol Treatment Trialists' Collaboration (CTTC) and UK Biobank cohort, was assessed among participants ≥70 years old at (re)surveys in UK Biobank and the Whitehall II studies. The model projected participants' cardiovascular risks, survival, quality-adjusted life years (QALYs) and healthcare costs (2021 UK£) with and without lifetime standard (35%-45% low-density lipoprotein cholesterol reduction) or higher intensity (≥45% reduction) statin therapy. CTTC individual participant data and other meta-analyses informed statins' effects on cardiovascular risks, incident diabetes, myopathy and rhabdomyolysis. Sensitivity of findings to smaller CVD risk reductions and to hypothetical further adverse effects with statins were assessed.</p>
RESULTS: In categories of men and women ≥70 years old without (15,019) and with (5,103) prior CVD, lifetime use of a standard statin increased QALYs by 0.24-0.70 and a higher intensity statin by a further 0.04-0.13 QALYs per person. Statin therapies were cost-effective with an incremental cost per QALY gained below £3502/QALY for standard and below £11778/QALY for higher intensity therapy and with high probability of being cost-effective. In sensitivity analyses, statins remained cost-effective although with larger uncertainty in cost-effectiveness among older people without prior CVD.</p>
CONCLUSIONS: Based on current evidence for the effects of statin therapy and modelling analysis, statin therapy improved health outcomes cost-effectively for men and women ≥70 years old.</p>
16 Keywords
- Age Factors
- Aged
- Aged, 80 and over
- Cardiovascular Diseases
- Cost-Benefit Analysis
- Drug Costs
- Female
- Heart Disease Risk Factors
- Humans
- Hydroxymethylglutaryl-CoA Reductase Inhibitors
- Male
- Models, Economic
- Quality-Adjusted Life Years
- Risk Assessment
- Treatment Outcome
- United Kingdom
176 Authors
- Borislava Mihaylova
- Runguo Wu
- Junwen Zhou
- Claire Williams
- Iryna Schlackow
- Jonathan Emberson
- Christina Reith
- Anthony Keech
- John Robson
- Richard Parnell
- Jane Armitage
- Alastair Gray
- John Simes
- Colin Baigent
- J Armitage
- C Baigent
- E Barnes
- L Blackwell
- R Collins
- K Davies
- J Emberson
- J Fulcher
- H Halls
- WG Herrington
- L Holland
- A Keech
- A Kirby
- B Mihaylova
- R O'Connell
- D Preiss
- C Reith
- J Simes
- K Wilson
- M Blazing
- E Braunwald
- J de Lemos
- S Murphy
- TR Pedersen
- M Pfeffer
- H White
- S Wiviott
- M Clearfield
- Downs
- A Gotto
- S Weis
- B Fellström
- H Holdaas
- A Jardine
- TR Pedersen
- D Gordon
- B Davis
- C Furberg
- R Grimm
- S Pressel
- JL Probstfield
- M Rahman
- L Simpson
- M Koren
- B Dahlöf
- A Gupta
- N Poulter
- P Sever
- H Wedel
- RH Knopp
- S Cobbe
- B Fellström
- H Holdaas
- A Jardine
- R Schmieder
- F Zannad
- DJ Betteridge
- HM Colhoun
- PN Durrington
- J Fuller
- GA Hitman
- A Neil
- E Braunwald
- B Davis
- CM Hawkins
- L Moyé
- M Pfeffer
- F Sacks
- J Kjekshus
- H Wedel
- J Wikstrand
- C Wanner
- V Krane
- Franzosi
- R Latini
- D Lucci
- A Maggioni
- R Marchioli
- EB Nicolis
- L Tavazzi
- G Tognoni
- J Bosch
- E Lonn
- S Yusuf
- J Armitage
- L Bowman
- R Collins
- A Keech
- M Landray
- S Parish
- R Peto
- P Sleight
- JJP Kastelein
- TR Pedersen
- R Glynn
- A Gotto
- JJP Kastelein
- W Koenig
- J MacFadyen
- PM Ridker
- A Keech
- S MacMahon
- I Marschner
- A Tonkin
- J Shaw
- J Simes
- H White
- PW Serruys
- G Knatterud
- GJ Blauw
- S Cobbe
- I Ford
- P Macfarlane
- C Packard
- N Sattar
- J Shepherd
- S Trompet
- E Braunwald
- CP Cannon
- S Murphy
- R Collins
- J Armitage
- L Bowman
- R Bulbulia
- R Haynes
- S Parish
- R Peto
- P Sleight
- P Amarenco
- KM Welch
- J Kjekshus
- TR Pedersen
- L Wilhelmsen
- P Barter
- A Gotto
- J LaRosa
- JJP Kastelein
- J Shepherd
- S Cobbe
- I Ford
- S Kean
- P Macfarlane
- C Packard
- M Roberston
- N Sattar
- J Shepherd
- R Young
- H Arashi
- R Clarke
- M Flather
- S Goto
- U Goldbourt
- J Hopewell
- GK Hovingh
- G Kitas
- C Newman
- Sabatine
- GG Schwartz
- L Smeeth
- J Tobert
- J Varigos
- J Yamamguchi
1 Application
| Application ID | Title |
|---|---|
| 56757 | Developing chronic disease models to inform health policy and guide treatment decisions |
Enabling scientific discoveries that improve human health