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Lifetime effects and cost-effectiveness of statin therapy for older people in the United Kingdom: a modelling study
Borislava Mihaylova1,2, Runguo Wu2, Junwen Zhou3
1Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK boby.mihaylova@dph.ox.ac.uk.
Insights
Statin therapy is a cost-effective way to improve cardiovascular health outcomes for older adults aged 70 and above. This study demonstrates that statins improve quality-adjusted life years (QALYs) and are cost-effective for this demographic.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Health Economics
Background:
- Cardiovascular disease (CVD) risk escalates with age, yet statin efficacy in older populations remains less certain.
- This study addresses the long-term effects and cost-effectiveness of statin therapy in contemporary UK older adults.
Purpose of the Study:
- To assess the long-term effectiveness and cost-effectiveness of statin therapy in individuals aged 70 years and older.
- To utilize a recent meta-analysis of randomized evidence and a validated CVD model for comprehensive analysis.
Main Methods:
- A CVD microsimulation model was developed and validated using UK Biobank and Whitehall II cohort data.
- The model projected cardiovascular risks, survival, quality-adjusted life years (QALYs), and healthcare costs with standard and higher-intensity statin therapy.
- Data from the Cholesterol Treatment Trialists' Collaboration (CTTC) informed statin effects on CVD risks and adverse events.
Main Results:
- Lifetime standard statin use increased QALYs by 0.24-0.70 per person, with higher-intensity statins adding 0.04-0.13 QALYs.
- Statin therapies demonstrated cost-effectiveness, with incremental costs per QALY gained below £3502 for standard and £11778 for higher-intensity therapy.
- Sensitivity analyses confirmed statins' cost-effectiveness, though with increased uncertainty in individuals without prior CVD.
Conclusions:
- Statin therapy significantly improved health outcomes in men and women aged 70 and older.
- The findings support the cost-effective use of statin therapy for older populations based on current evidence and modeling.
- Statin treatment offers a beneficial health economic profile for elderly individuals at risk of cardiovascular disease.
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.
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.
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.
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.
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