Lifetime effects and cost-effectiveness of standard and higher-intensity statin therapy across population categories in the UK: a microsimulation modelling studyResearch in context

Borislava Mihaylova; Runguo Wu; Junwen Zhou; Claire Williams; Iryna Schlackow; Jonathan Emberson; Christina Reith; Anthony Keech; John Robson; Richard Parnell; Jane Armitage; Alastair Gray; John Simes; Colin Baigent

The Lancet Regional Health. Europe (May 2024)

Lifetime effects and cost-effectiveness of standard and higher-intensity statin therapy across population categories in the UK: a microsimulation modelling studyResearch in context

Borislava Mihaylova,
Runguo Wu,
Junwen Zhou,
Claire Williams,
Iryna Schlackow,
Jonathan Emberson,
Christina Reith,
Anthony Keech,
John Robson,
Richard Parnell,
Jane Armitage,
Alastair Gray,
John Simes,
Colin Baigent

Affiliations

Borislava Mihaylova: Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Health Economics and Policy Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK; Corresponding author. Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK.
Runguo Wu: Health Economics and Policy Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
Junwen Zhou: Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
Claire Williams: Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
Iryna Schlackow: Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
Jonathan Emberson: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, University of Oxford, UK
Christina Reith: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
Anthony Keech: NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
John Robson: Clinical Effectiveness Group, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
Richard Parnell: Patient and Public Representative, UK
Jane Armitage: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, University of Oxford, UK
Alastair Gray: Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
John Simes: NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
Colin Baigent: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, University of Oxford, UK

Journal volume & issue: Vol. 40
p. 100887

Abstract

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Summary: Background: 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. Methods: 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. Findings: 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. Interpretation: 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. Funding: UK NIHR Health Technology Assessment Programme (17/140/02).

Published in The Lancet Regional Health. Europe

ISSN: 2666-7762 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Public aspects of medicine
Website: https://www.thelancet.com/journals/lanepe/home

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