Statin cost-effectiveness in the United States for people at different vascular risk levels

Heart Protection Study Collaborative Group

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Background-Statins reduce the rates of heart attacks, strokes, and revascularization procedures (ie, major vascular events) in a wide range of circumstances. Randomized controlled trial data from 20 536 adults have been used to estimate the cost-effectiveness of prescribing statin therapy in the United States for people at different levels of vascular disease risk and to explore whether wider use of generic statins beyond the populations currently recommended for treatment in clinical guidelines is indicated. Methods and Results-Randomized controlled trial data, an internally validated vascular disease model, and US costs of statin therapy and other medical care were used to project lifetime risks of vascular events and evaluate the cost-effectiveness of 40 mg simvastatin daily. For an average of 5 years, allocation to simvastatin reduced the estimated US costs of hospitalizations for vascular events by ≈ 20% (95% CI, 15 to 24) in the different subcategories of participants studied. At a daily cost of $1 for 40 mg generic simvastatin, the estimated costs of preventing a vascular death within the 5-year study period ranged from a net saving of $1300 (95% CI, $15 600 saving to $13 200 cost) among participants with a 42% 5-year major vascular event risk to a net cost of $216 500 ($123 700 to $460 000 cost) among those with a 12% 5-year risk. The costs per life year gained with lifetime simvastatin treatment ranged from $2500 (-$40 to $3820) in people aged 40 to 49 years with a 42% 5-year major vascular event risk to $10 990 ($9430 to $14 700) in people aged 70 years and older with a 12% 5-year risk. Conclusions-Treatment with generic simvastatin appears to be cost-effective for a much wider population in the United States than that recommended by current guidelines.

Original languageEnglish (US)
Pages (from-to)65-72
Number of pages8
JournalCirculation: Cardiovascular Quality and Outcomes
Volume2
Issue number2
DOIs
StatePublished - 2009
Externally publishedYes

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Cost-Benefit Analysis
Blood Vessels
Simvastatin
Costs and Cost Analysis
Vascular Diseases
Randomized Controlled Trials
Guidelines
Therapeutics
Population
Hospitalization
Stroke
Myocardial Infarction

Keywords

  • Cardiovascular diseases
  • Cost-benefit analysis
  • Statin intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Statin cost-effectiveness in the United States for people at different vascular risk levels. / Heart Protection Study Collaborative Group.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 2, No. 2, 2009, p. 65-72.

Research output: Contribution to journalArticle

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title = "Statin cost-effectiveness in the United States for people at different vascular risk levels",
abstract = "Background-Statins reduce the rates of heart attacks, strokes, and revascularization procedures (ie, major vascular events) in a wide range of circumstances. Randomized controlled trial data from 20 536 adults have been used to estimate the cost-effectiveness of prescribing statin therapy in the United States for people at different levels of vascular disease risk and to explore whether wider use of generic statins beyond the populations currently recommended for treatment in clinical guidelines is indicated. Methods and Results-Randomized controlled trial data, an internally validated vascular disease model, and US costs of statin therapy and other medical care were used to project lifetime risks of vascular events and evaluate the cost-effectiveness of 40 mg simvastatin daily. For an average of 5 years, allocation to simvastatin reduced the estimated US costs of hospitalizations for vascular events by ≈ 20{\%} (95{\%} CI, 15 to 24) in the different subcategories of participants studied. At a daily cost of $1 for 40 mg generic simvastatin, the estimated costs of preventing a vascular death within the 5-year study period ranged from a net saving of $1300 (95{\%} CI, $15 600 saving to $13 200 cost) among participants with a 42{\%} 5-year major vascular event risk to a net cost of $216 500 ($123 700 to $460 000 cost) among those with a 12{\%} 5-year risk. The costs per life year gained with lifetime simvastatin treatment ranged from $2500 (-$40 to $3820) in people aged 40 to 49 years with a 42{\%} 5-year major vascular event risk to $10 990 ($9430 to $14 700) in people aged 70 years and older with a 12{\%} 5-year risk. Conclusions-Treatment with generic simvastatin appears to be cost-effective for a much wider population in the United States than that recommended by current guidelines.",
keywords = "Cardiovascular diseases, Cost-benefit analysis, Statin intervention",
author = "{Heart Protection Study Collaborative Group} and Borislave Mihaylova and Andrew Briggs and Mark Hlatky and Jane Armitage and Sarah Parish and Alastair Gray and Rory Collins and R. Collins and T. Meade and P. Sleight and J. Armitage and S. Parish and R. Peto and L. Youngman and M. Buxton and {De Bono}, D. and C. George and J. Fuller and A. Keech and A. Mansfield and B. Pentecost and D. Simpson and C. Warlow and J. McNamara and L. O’Toole and R. Doll and L. Wilhelmsen and Fox, {K. M.} and C. Hill and P. Sandercock and N. Benjamin and J. Webster and J. Jamieson and L. Donald and R. Blandford and L. Carrington and H. McMahon and D. Cheetham and J. Reckless and L. Brice and R. Carpenter and J. Christmas and C. Flower and I. Cooper and S. Frampton and E. Pickerell and J. Wells and M. Scott and V. Crowe and Fisher, {John Devens}",
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journal = "Circulation: Cardiovascular Quality and Outcomes",
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T1 - Statin cost-effectiveness in the United States for people at different vascular risk levels

AU - Heart Protection Study Collaborative Group

AU - Mihaylova, Borislave

AU - Briggs, Andrew

AU - Hlatky, Mark

AU - Armitage, Jane

AU - Parish, Sarah

AU - Gray, Alastair

AU - Collins, Rory

AU - Collins, R.

AU - Meade, T.

AU - Sleight, P.

AU - Armitage, J.

AU - Parish, S.

AU - Peto, R.

AU - Youngman, L.

AU - Buxton, M.

AU - De Bono, D.

AU - George, C.

AU - Fuller, J.

AU - Keech, A.

AU - Mansfield, A.

AU - Pentecost, B.

AU - Simpson, D.

AU - Warlow, C.

AU - McNamara, J.

AU - O’Toole, L.

AU - Doll, R.

AU - Wilhelmsen, L.

AU - Fox, K. M.

AU - Hill, C.

AU - Sandercock, P.

AU - Benjamin, N.

AU - Webster, J.

AU - Jamieson, J.

AU - Donald, L.

AU - Blandford, R.

AU - Carrington, L.

AU - McMahon, H.

AU - Cheetham, D.

AU - Reckless, J.

AU - Brice, L.

AU - Carpenter, R.

AU - Christmas, J.

AU - Flower, C.

AU - Cooper, I.

AU - Frampton, S.

AU - Pickerell, E.

AU - Wells, J.

AU - Scott, M.

AU - Crowe, V.

AU - Fisher, John Devens

PY - 2009

Y1 - 2009

N2 - Background-Statins reduce the rates of heart attacks, strokes, and revascularization procedures (ie, major vascular events) in a wide range of circumstances. Randomized controlled trial data from 20 536 adults have been used to estimate the cost-effectiveness of prescribing statin therapy in the United States for people at different levels of vascular disease risk and to explore whether wider use of generic statins beyond the populations currently recommended for treatment in clinical guidelines is indicated. Methods and Results-Randomized controlled trial data, an internally validated vascular disease model, and US costs of statin therapy and other medical care were used to project lifetime risks of vascular events and evaluate the cost-effectiveness of 40 mg simvastatin daily. For an average of 5 years, allocation to simvastatin reduced the estimated US costs of hospitalizations for vascular events by ≈ 20% (95% CI, 15 to 24) in the different subcategories of participants studied. At a daily cost of $1 for 40 mg generic simvastatin, the estimated costs of preventing a vascular death within the 5-year study period ranged from a net saving of $1300 (95% CI, $15 600 saving to $13 200 cost) among participants with a 42% 5-year major vascular event risk to a net cost of $216 500 ($123 700 to $460 000 cost) among those with a 12% 5-year risk. The costs per life year gained with lifetime simvastatin treatment ranged from $2500 (-$40 to $3820) in people aged 40 to 49 years with a 42% 5-year major vascular event risk to $10 990 ($9430 to $14 700) in people aged 70 years and older with a 12% 5-year risk. Conclusions-Treatment with generic simvastatin appears to be cost-effective for a much wider population in the United States than that recommended by current guidelines.

AB - Background-Statins reduce the rates of heart attacks, strokes, and revascularization procedures (ie, major vascular events) in a wide range of circumstances. Randomized controlled trial data from 20 536 adults have been used to estimate the cost-effectiveness of prescribing statin therapy in the United States for people at different levels of vascular disease risk and to explore whether wider use of generic statins beyond the populations currently recommended for treatment in clinical guidelines is indicated. Methods and Results-Randomized controlled trial data, an internally validated vascular disease model, and US costs of statin therapy and other medical care were used to project lifetime risks of vascular events and evaluate the cost-effectiveness of 40 mg simvastatin daily. For an average of 5 years, allocation to simvastatin reduced the estimated US costs of hospitalizations for vascular events by ≈ 20% (95% CI, 15 to 24) in the different subcategories of participants studied. At a daily cost of $1 for 40 mg generic simvastatin, the estimated costs of preventing a vascular death within the 5-year study period ranged from a net saving of $1300 (95% CI, $15 600 saving to $13 200 cost) among participants with a 42% 5-year major vascular event risk to a net cost of $216 500 ($123 700 to $460 000 cost) among those with a 12% 5-year risk. The costs per life year gained with lifetime simvastatin treatment ranged from $2500 (-$40 to $3820) in people aged 40 to 49 years with a 42% 5-year major vascular event risk to $10 990 ($9430 to $14 700) in people aged 70 years and older with a 12% 5-year risk. Conclusions-Treatment with generic simvastatin appears to be cost-effective for a much wider population in the United States than that recommended by current guidelines.

KW - Cardiovascular diseases

KW - Cost-benefit analysis

KW - Statin intervention

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