| Summary: | <p><strong>Background:</strong> 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 costeffectiveness 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>
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<p><strong>Methods:</strong> The performance of the CVD micro-simulation 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% LDL 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>
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<p><strong>Results:</strong> 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 0.33-0.51 and a higher intensity statin by a
further 0.06-0.10 QALYs per person. Statin therapies were cost-effective with an incremental cost per QALY gained below £3510/QALY for standard and below £11800/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>
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<p><strong>Conclusions:</strong> Based on current evidence for effects of statin therapy and modelling analysis, statin therapy improved health outcomes cost-effectively for men and women ≥70 years old.</p>
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