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The West of Scotland coronary prevention study: economic benefit analysis of primary prevention with pravastatin

^a Caro Research, 336 Baker Avenue, Concord, MA 01742, USA, ^b City University, Department of Economics, London EC1V 0HB, ^c University of Glasgow, Robertson Centre for Biostatistics, Glasgow G12 8QQ, ^d Bristol-Myers Squibb Outcomes Research, PO Box 4000, Princeton, NJ 08543, USA, ^e University of Glasgow, CRI in Heart Failure, Wolfson Building, Glasgow G12 8QQ, ^f Department of Pathological Biochemistry, Royal Infirmary, Glasgow G4 0SF

The members of the executive committee are listed at the end of the article.Correspondence to: Dr Caro jcaro@caroresearch.com

Objective: To estimate the economic efficiency of using pravastatin to prevent the transition from health to cardiovascular disease in men with hypercholesterolaemia.
Design: Economic benefit analysis based on data from the West of Scotland coronary prevention study. Treatment specific hazards of developing cardiovascular disease according to various definitions were estimated. Scottish record linkage data provided disease specific survival. Cost estimates were based on extracontractual tariffs and event specific average lengths of stay calculated from the West of Scotland coronary prevention study.
Subjects: Men with hypercholesterolaemia similar to the subjects in the West of Scotland coronary prevention study.
Main outcome: Cost consequences, the number of transitions from health to cardiovascular disease prevented, the number needed to start treatment, and cost per life year gained.
Results: If 10 000 of these men started taking pravastatin, 318 of them would not make the transition from health to cardiovascular disease (number needed to treat, 31.4), at a net discounted cost of £20m over 5 years. These benefits imply an undiscounted gain of 2460 years of life, and thus £8121 per life year gained, or £20 375 per life year gained if benefits are discounted. Restriction to the 40% of men at highest risk reduces the number needed to treat to 22.5 (£5601 per life year gained (undiscounted) and £13 995 per life year gained (discounted)).
Conclusions: In subjects without evidence of prior myocardial infarction but who have hypercholesterolaemia, the use of pravastatin yields substantial health benefits at a cost that is not prohibitive overall and can be quite efficient in selected high risk subgroups.

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Economic benefit analysis of primary prevention with pravastatin

Paul Pharoah, Nick Freemantle, James Mason, and J Jaime Caro
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