Article Impact Level: HIGH Data Quality: STRONG Summary of Heart. https://doi.org/10.1136/heartjnl-2024-324052 Dr. Borislava Mihaylova et al.
Points
- A study evaluated statin therapy’s long-term effects and cost-effectiveness in UK adults aged 70 and older, focusing on the prevention of cardiovascular disease (CVD).
- The cardiovascular disease microsimulation model projected improved survival rates, quality-adjusted life years (QALYs), and healthcare costs for 15,019 participants without CVD and 5,103 with prior CVD.
- Standard statin therapy increased QALYs by 0.24 to 0.70 per person, while higher-intensity statins added an extra 0.04 to 0.13 QALYs, making both therapies cost-effective.
- The incremental cost per QALY was below £3,502 for standard statin therapy and below £11,778 for higher-intensity therapy, demonstrating high cost-effectiveness even after sensitivity analyses.
- The study supports prescribing statins to adults aged ≥70 years for primary and secondary CVD prevention, emphasizing that the benefits outweigh the costs, with some uncertainty for those without prior CVD.
Summary
A recent study assessed statin therapy’s long-term effects and cost-effectiveness in adults aged 70 and older within the contemporary UK population. Recognizing that cardiovascular disease (CVD) risk escalates with age and that the efficacy of statins in older individuals remains uncertain, researchers utilized a newly validated cardiovascular disease microsimulation model. This model was developed using Cholesterol Treatment Trialists’ Collaboration (CTTC) data and the UK Biobank cohort. The study evaluated participants from the UK Biobank and the Whitehall II studies, totaling 15,019 individuals without prior CVD and 5,103 with prior CVD, all aged ≥70 years. The model projected cardiovascular risks, survival rates, quality-adjusted life years (QALYs), and healthcare costs with and without lifetime use of standard (35%–45% LDL cholesterol reduction) or higher-intensity (≥45% LDL cholesterol reduction) statin therapy.
The results indicated that lifetime use of standard statin therapy increased QALYs by 0.24 to 0.70 per person among men and women aged ≥70 years, regardless of prior CVD status. Higher-intensity statin therapy provided an additional increase of 0.04 to 0.13 QALYs per person. Cost-effectiveness analysis revealed that statin therapies were economically favorable, with an incremental cost per QALY gained below £3,502 for standard therapy and below £11,778 for higher-intensity therapy. These figures demonstrate a high probability of cost-effectiveness. Sensitivity analyses, which accounted for smaller CVD risk reductions and hypothetical additional adverse effects of statins, confirmed that statins remained cost-effective. However, there was more significant uncertainty among older individuals without prior CVD.
The study concludes that, based on current evidence and modeling analyses, statin therapy improves health outcomes cost-effectively for men and women aged ≥70 years. These findings support the use of statins for both primary and secondary prevention of CVD in older adults. Clinicians should consider prescribing statin therapy to elderly patients to reduce cardiovascular events and enhance quality-adjusted life expectancy, as the benefits outweigh the costs even when accounting for potential risks.
Link to the article: https://heart.bmj.com/content/early/2024/08/06/heartjnl-2024-324052
References Mihaylova, B., Wu, R., Zhou, J., Williams, C., Schlackow, I., Emberson, J., Reith, C., Keech, A., Robson, J., Parnell, R., Armitage, J., Gray, A., Simes, J., & Baigent, C. (2024). Lifetime effects and cost-effectiveness of statin therapy for older people in the United Kingdom: A modelling study. Heart. https://doi.org/10.1136/heartjnl-2024-324052
