Lifetime effects and cost-effectiveness of statin therapy for older people in the United Kingdom: a modelling study
<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...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
BMJ Publishing Group
2024
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| _version_ | 1811141318050578432 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Mihaylova, B |
| collection | OXFORD |
| description | <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>
<br>
<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>
<br>
<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>
<br>
<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> |
| first_indexed | 2024-09-25T04:35:58Z |
| format | Journal article |
| id | oxford-uuid:060327c4-2fea-4e6f-9251-5653cfabb3c4 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-09-25T04:35:58Z |
| publishDate | 2024 |
| publisher | BMJ Publishing Group |
| record_format | dspace |
| spelling | oxford-uuid:060327c4-2fea-4e6f-9251-5653cfabb3c42024-09-24T10:29:47ZLifetime effects and cost-effectiveness of statin therapy for older people in the United Kingdom: a modelling studyJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:060327c4-2fea-4e6f-9251-5653cfabb3c4EnglishSymplectic ElementsBMJ Publishing Group2024Mihaylova, BWu, RZhou, JWilliams, CSchlackow, IEmberson, JReith, CKeech, ARobson, JParnell, RArmitage, JGray, ASimes, JBaigent, C<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> <br> <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> <br> <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> <br> <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> |
| spellingShingle | 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 Lifetime effects and cost-effectiveness of statin therapy for older people in the United Kingdom: a modelling study |
| title | Lifetime effects and cost-effectiveness of statin therapy for older people in the United Kingdom: a modelling study |
| title_full | Lifetime effects and cost-effectiveness of statin therapy for older people in the United Kingdom: a modelling study |
| title_fullStr | Lifetime effects and cost-effectiveness of statin therapy for older people in the United Kingdom: a modelling study |
| title_full_unstemmed | Lifetime effects and cost-effectiveness of statin therapy for older people in the United Kingdom: a modelling study |
| title_short | Lifetime effects and cost-effectiveness of statin therapy for older people in the United Kingdom: a modelling study |
| title_sort | lifetime effects and cost effectiveness of statin therapy for older people in the united kingdom a modelling study |
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