Lifetime effects and cost-effectiveness of standard and higher-intensity statin therapy across population categories in the UK: a microsimulation modelling study
<p><strong>Background</p></strong> Cardiovascular disease incidence and mortality have declined across developed economies and granular up-to-date cost-effectiveness evidence is required for treatments targeting large populations. To assess the health benefits and cost-effect...
| Asıl Yazarlar: | , , , , , , , , , , , , , |
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| Materyal Türü: | Journal article |
| Dil: | English |
| Baskı/Yayın Bilgisi: |
Elsevier
2024
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| _version_ | 1826313294744387584 |
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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</p></strong>
Cardiovascular disease incidence and mortality have declined across developed economies and granular up-to-date cost-effectiveness evidence is required for treatments targeting large populations. To assess the health benefits and cost-effectiveness of standard and higher intensity statin therapy in the contemporary UK population 40–70 years old.
<p><strong>Methods</p></strong>
A cardiovascular disease microsimulation model, developed using the Cholesterol Treatment Trialists' Collaboration data (117,896 participants; 5 years follow-up), and calibrated in the UK Biobank cohort (501,854 participants; 9 years follow-up), projected risks of myocardial infarction, stroke, coronary revascularization, diabetes, cancer and vascular and nonvascular death for all UK Biobank participants without and with statin treatment. Meta-analyses of trials and cohort studies informed statins’ relative effects on cardiovascular events, incident diabetes, myopathy and rhabdomyolysis. UK healthcare perspective was taken (2020/2021 UK£) with costs per 28 tablets of £1.10 for standard (35%–45% LDL cholesterol (LDL-C) reduction) and £1.68 for higher intensity (≥45% LDL-C reduction) generic statin.
<p><strong>Findings</p></strong>
Across categories by sex, age, LDL-C, and cardiovascular disease history/10-year cardiovascular risk, lifetime standard statin increased survival by 0.28–1.85 years (0.20–1.09 quality-adjusted life years (QALYs)), and higher intensity statin by further 0.06–0.40 years (0.03–0.20 QALYs) per person. Standard statin was cost-effective across all categories with incremental cost per QALY from £280 to £8530, with higher intensity statin cost-effective at higher cardiovascular risks and higher LDL-C levels. Stopping statin early reduced benefits and was not cost-effective.
<p><strong>Interpretation</p></strong>
Lifetime low-cost statin therapy is cost-effective across all 40–70 years old in UK. Strengthening and widening statin treatment could cost-effectively improve population health.
<p><strong>Funding</p></strong>
UK NIHR Health Technology Assessment Programme (17/140/02). |
| first_indexed | 2024-03-07T08:29:22Z |
| format | Journal article |
| id | oxford-uuid:91bea057-55e0-4c96-b54b-b6470c9e0f73 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-09-25T04:10:47Z |
| publishDate | 2024 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | oxford-uuid:91bea057-55e0-4c96-b54b-b6470c9e0f732024-06-19T09:15:05ZLifetime effects and cost-effectiveness of standard and higher-intensity statin therapy across population categories in the UK: a microsimulation modelling studyJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:91bea057-55e0-4c96-b54b-b6470c9e0f73EnglishSymplectic ElementsElsevier2024Mihaylova, BWu, RZhou, JWilliams, CSchlackow, IEmberson, JReith, CKeech, ARobson, JParnell, RArmitage, JGray, ASimes, JBaigent, C<p><strong>Background</p></strong> Cardiovascular disease incidence and mortality have declined across developed economies and granular up-to-date cost-effectiveness evidence is required for treatments targeting large populations. To assess the health benefits and cost-effectiveness of standard and higher intensity statin therapy in the contemporary UK population 40–70 years old. <p><strong>Methods</p></strong> A cardiovascular disease microsimulation model, developed using the Cholesterol Treatment Trialists' Collaboration data (117,896 participants; 5 years follow-up), and calibrated in the UK Biobank cohort (501,854 participants; 9 years follow-up), projected risks of myocardial infarction, stroke, coronary revascularization, diabetes, cancer and vascular and nonvascular death for all UK Biobank participants without and with statin treatment. Meta-analyses of trials and cohort studies informed statins’ relative effects on cardiovascular events, incident diabetes, myopathy and rhabdomyolysis. UK healthcare perspective was taken (2020/2021 UK£) with costs per 28 tablets of £1.10 for standard (35%–45% LDL cholesterol (LDL-C) reduction) and £1.68 for higher intensity (≥45% LDL-C reduction) generic statin. <p><strong>Findings</p></strong> Across categories by sex, age, LDL-C, and cardiovascular disease history/10-year cardiovascular risk, lifetime standard statin increased survival by 0.28–1.85 years (0.20–1.09 quality-adjusted life years (QALYs)), and higher intensity statin by further 0.06–0.40 years (0.03–0.20 QALYs) per person. Standard statin was cost-effective across all categories with incremental cost per QALY from £280 to £8530, with higher intensity statin cost-effective at higher cardiovascular risks and higher LDL-C levels. Stopping statin early reduced benefits and was not cost-effective. <p><strong>Interpretation</p></strong> Lifetime low-cost statin therapy is cost-effective across all 40–70 years old in UK. Strengthening and widening statin treatment could cost-effectively improve population health. <p><strong>Funding</p></strong> UK NIHR Health Technology Assessment Programme (17/140/02). |
| 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 standard and higher-intensity statin therapy across population categories in the UK: a microsimulation modelling study |
| title | Lifetime effects and cost-effectiveness of standard and higher-intensity statin therapy across population categories in the UK: a microsimulation modelling study |
| title_full | Lifetime effects and cost-effectiveness of standard and higher-intensity statin therapy across population categories in the UK: a microsimulation modelling study |
| title_fullStr | Lifetime effects and cost-effectiveness of standard and higher-intensity statin therapy across population categories in the UK: a microsimulation modelling study |
| title_full_unstemmed | Lifetime effects and cost-effectiveness of standard and higher-intensity statin therapy across population categories in the UK: a microsimulation modelling study |
| title_short | Lifetime effects and cost-effectiveness of standard and higher-intensity statin therapy across population categories in the UK: a microsimulation modelling study |
| title_sort | lifetime effects and cost effectiveness of standard and higher intensity statin therapy across population categories in the uk a microsimulation modelling study |
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