Health-economic evaluation of statins versus lifestyle changes for cardiovascular disease prevention

The German Federal Ministry of Health aims to improve cardiovascular health by expanding statin eligibility. However, the shift in funding from lifestyle-based preventive programs to statins has raised concerns that existing prevention efforts could be undermined. This study assessed the cost-effectiveness of statins compared with lifestyle interventions for the prevention of cardiovascular disease (CVD) in Germany under constrained healthcare budgets.

A cost-effectiveness analysis was conducted using secondary data. Effectiveness data for statins were drawn from meta-analyses and systematic reviews, showing a 26% reduction in major cardiovascular events. Lifestyle intervention data were derived from the US Preventive Services Task Force (2020), reporting a relative risk of 0.80 for CVD events. A z-score test compared the effectiveness, while a Bayesian analysis assessed the probability of statins being more effective. Costs were analyzed from the perspective of German statutory health insurance (SHI) enrollees, including copayments and treatment monitoring expenses.

The z-score of -1.26 (p = 0.207) indicated no statistically significant difference in the effectiveness of statins compared to lifestyle interventions. However, Bayesian analysis estimated an 89.7% probability that statins are more effective. Statins were generally cheaper, especially when preventive courses are repeated annually.

Statins likely offer higher cost-effectiveness than lifestyle changes, though the difference in benefits is not statistically significant. Concerns about reallocating funds from lifestyle programs to statins are somewhat mitigated by these findings.