Assessing long-term effectiveness and cost-effectiveness of statin therapy in the UK: a modelling study using individual participant data sets
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Why the study?
Cardiovascular disease has declined but remains a major disease burden across developed countries, prompting an assessment of the effectiveness and cost-effectiveness of statin therapy across UK population categories.
Does lifetime standard or higher-intensity statin therapy improve quality-adjusted life-years and cost-effectiveness in UK adults aged ≥ 40 years?
Population
20,122 UK Biobank and Whitehall II participants aged ≥ 70 years and participants 40-70 years old
Comparison
Lifetime standard vs higher-intensity statin therapy
Design
Microsimulation modelling study
Follow-up
Lifetime
Authors
Discussion
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Implication
Supports statin cost-effectiveness in UK adults ≥40; leaves open need for prospective trials to confirm real-world impact.
Key Points
- To assess the long-term clinical effectiveness and cost-effectiveness of lifetime standard and higher-intensity statin therapy across demographic and cardiovascular risk categories.
- Developed a cardiovascular disease microsimulation model using individual participant data from the Cholesterol Treatment Trialists' Collaboration, UK Biobank, and Whitehall II cohorts (N=20,122 aged ≥70 years).
- Simulated lifetime standard (35–45% LDL cholesterol reduction) versus higher-intensity (≥45% reduction) generic statin therapy across categories of age (40–70 and ≥70 years), baseline cardiovascular disease risk, and LDL cholesterol levels.
- Estimated lifetime quality-adjusted life-years (QALYs), adverse events, and incremental cost per QALY gained from the UK healthcare perspective at a £20,000 per QALY willingness-to-pay threshold.
- Lifetime standard statin therapy gained an undiscounted 0.20–1.09 QALYs per person aged 40–70 years and 0.24–0.70 QALYs per person aged ≥70 years; higher-intensity statin added a further 0.03–0.20 and 0.04–0.13 QALYs, respectively.
- Standard statin therapy was cost-effective across all participant groups, with an incremental cost per QALY gained of £280–£8,530 for ages 40–70 years and under £3,500 for ages ≥70 years.
- Higher-intensity statin therapy was cost-effective for individuals with higher baseline cardiovascular risk or higher LDL cholesterol, with incremental costs per QALY gained under £11,780 for individuals aged ≥70 years.
Structured PICO
Does lifetime standard or higher-intensity statin therapy improve quality-adjusted life-years and cost-effectiveness in UK adults aged ≥ 40 years?
P
Population
Men and women aged ≥ 40 years in the United Kingdom, including 20,122 UK Biobank and Whitehall II participants aged ≥ 70 years, categorized by previous cardiovascular disease status, sex, and low-density lipoprotein cholesterol level.
I
Intervention
Lifetime standard (35-45% low-density lipoprotein cholesterol reduction) or higher-intensity (≥ 45% reduction) statin therapy.
C
Comparator
Baseline/no statin therapy, and standard statin therapy compared to higher-intensity statin therapy.
O
Outcome
Quality-adjusted life-years (QALYs) and incremental cost per quality-adjusted life-year gained from the United Kingdom healthcare perspective.
Lifetime standard and higher-intensity statin therapies are highly cost-effective for preventing cardiovascular disease across all adult populations aged ≥40 years in the UK.
Limitations
- The randomised evidence for effects of statin therapy is for about 5 years of treatment.
- There is limited randomised evidence of the effects of statin therapy in older people without previous cardiovascular disease.
Cite This Study
Mihaylova et al. (2024) studied this question.
Topics
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