Lifetime Statin Therapy Cost-Effective, Improves Senior Health Outcomes

Borislava Mihaylova, MSc, DPhil

Credit: University of Oxford

A foundation of cardiovascular disease (CVD) prevention, statin therapy is likely to be cost-effective and enhance health outcomes for men and women aged ≥70 years old, according to a modeling study analysis in the United Kingdom.¹

These contemporary patient data showed that lifetime statin use benefited quality-of-life adjusted survival in older men and women, regardless of the history of CVD or low-density lipoprotein cholesterol (LDL-C) levels, and remained economical with the cost of generic statins.

“While further randomized evidence will be helpful, the robustness of these findings indicates that older people are likely to benefit cost-effectively from statin therapy and should be considered for treatment,” wrote the investigative team, led by Borislava Mihaylova, MSc, DPhil, Health Economics Research Center, Nuffield Department of Population Health, University of Oxford.²

Available literature has demonstrated the effectiveness of statins for reducing cardiovascular risk, with regimen intensity linked to larger LDL-C reductions, and thus, prevention of further cardiovascular events.³ Statin therapy can reduce events by about 25% for every 1mmol/L reduction in LDL-C.⁴

However, fewer data are reported on the benefit of statins for older patients without CVD history and guidelines do not specifically recommend statin initiation for primary CVD prevention in the older population.

For this study, Mihaylova and colleagues evaluated the lifetime effect and cost of statin therapy for older adults in the contemporary UK population, categorized by prior CVD, sex, and LDL-C level, using a recent meta-analysis of randomized evidence of statin benefit, as well as a recently validated CVD model.¹

A CVD microsimulation model was developed using the Cholesterol Treatment Trialists’ Collaboration (CTTC) and UK Biobank cohorts to project the first occurrence of cardiovascular events. In this current study, the model’s performance was evaluated against participants aged ≥70 years during follow-up in the UK Biobank and the Whitehall II studies.

The model projected cardiovascular event risks and survival while summarizing life-years, quality-adjusted life years (QALYs), and primary and hospital care costs over each participant’s remaining lifetimes without and with standard and high-intensity statin therapy regimens. In addition, the model predicted the cost-effectiveness of different statin therapies across cohorts of older participants.

A total of 15,019 (52% men) participants without CVD and 5103 (66% men) with a history of CVD were assessed in this study. Among those without and with prior CVD, a statin was prescribed at baseline for 29% and 58%, respectively. Untreated mean LDL-C levels were 4.2 mmol/L and 4/3 mmol/L for these cohorts, respectively.

Among participants categorized by sex, prior CVD, and LDL-C level, standard statin therapy was projected to benefit individual survival by 0.37 to 1.05 life years (0.24 to 0.7 QALYs). Higher-intensity statin regimens further increased survival by 0.08 to 0.21 life years (0.04 to 0.13 QALYs).

For these categories, the incremental cost per QALY gained for standard statin therapy compared with no statin therapy ranged from £116 to £3502. For the higher-intensity regimen, the incremental cost compared with standard statin ranged from £2213 to £11,778 per QALY.

Mihaylova and colleagues indicated, that at the £20,000/QALY willingness to pay threshold, higher-intensity statin therapy had a higher probability of remaining cost-effective across all cohorts of men and women aged ≥70 years.

Results on the cost-effectiveness remained strong across a range of sensitivity analyses, with particularly high sensitivity for a higher-intensity statin at a 5-times higher price. However, Mihaylova and colleagues indicated there was larger uncertainty regarding statin therapy’s cost-effectiveness for older people without prior CVD.

“In conclusion, this study reports that statin therapy is highly likely to be cost-effective in older people, although there was greater uncertainty among older people without CVD in scenario analysis with substantially smaller CVD risk reductions with statin therapy,” they wrote.

References

1. _{Mihaylova B, Wu R, Zhou J, Williams C, Schlackow I, et al. Lifetime effects and cost-effectiveness of statin therapy for older people in the United Kingdom: a modeling study. Heart. Published September 10, 2024. Accessed September 10, 2024. doi:10.1136/heartjnl-2024-324052}
2. _{EurekAlert. Statins cost-effective and linked to better health outcomes in older people. Published September 10, 2024. Accessed September 10, 2024. https://www.eurekalert.org/news-releases/1057102}
3. _{Cholesterol Treatment Trialists' Collaboration. Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials. Lancet. 2019;393(10170):407-415. doi:10.1016/S0140-6736(18)31942-1}
4. _{Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in Circulation. 2019 Jun 18;139(25):e1182-e1186. doi: 10.1161/CIR.0000000000000698] [published correction appears in Circulation. 2023 Aug 15;148(7):e5. doi: 10.1161/CIR.0000000000001172]. Circulation. 2019;139(25):e1082-e1143. doi:10.1161/CIR.0000000000000625}