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

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

doi:10.1016/j.lanepe.2024.100887

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

Lancet Reg Health Eur. 2024 Mar 22:40:100887. doi: 10.1016/j.lanepe.2024.100887. eCollection 2024 May.

Authors

Borislava Mihaylova^{1

2}, Runguo Wu², Junwen Zhou¹, Claire Williams¹, Iryna Schlackow¹, Jonathan Emberson^{3

4}, Christina Reith³, Anthony Keech⁵, John Robson⁶, Richard Parnell⁷, Jane Armitage^{3

4}, Alastair Gray¹, John Simes⁵, Colin Baigent^{3

4}

Affiliations

¹ Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
² Health Economics and Policy Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
³ Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
⁴ MRC Population Health Research Unit, University of Oxford, UK.
⁵ NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia.
⁶ Clinical Effectiveness Group, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
⁷ Patient and Public Representative, UK.

Abstract

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).

Keywords: Cardiovascular diseases; Cost-effectiveness; Health care costs; Microsimulation model; Quality-adjusted life years; Statin.