Lifetime cost effectiveness of simvastatin in a range of risk groups and age groups derived from a randomised trial of 20 536 people

doi:10.1136/bmj.38993.731725.BE

BMJ, doi: 10.1136/bmj.38993.731725.BE, (Published 10 November 2006)

RESEARCH

Lifetime cost effectiveness of simvastatin in a range of risk groups and age groups derived from a randomised trial of 20 536 people

Heart Protection Study Collaborative Group

Objectives To evaluate the cost effectiveness of 40 mg simvastatindaily continued for life in people of different ages with differingrisks of vascular disease.

Design A model developed from a randomisedtrial was used to estimate lifetime risks of vascular eventsand costs of treatment and hospital admissions in the UnitedKingdom.

Setting 69 hospitals in the UK.

Participants 20 536men and women (aged 40-80) with coronary disease, other occlusivearterial disease, or diabetes.

Interventions 40 mg simvastatindaily versus placebo for an average of 5 years.

Main outcomemeasures Cost effectiveness of 40 mg simvastatin daily expressedas additional cost per life year gained. Major vascular eventdefined as non-fatal myocardial infarction or death from coronarydisease, any stroke, or revascularisation procedure. Resultswere extrapolated to younger and older age groups at lower riskof vascular disease than were studied directly, as well as tolifetime treatment.

Results At the April 2005 UK price of £4.87( ${euro}$ 7; $9) per 28 day pack of generic 40 mg simvastatin, lifetimetreatment was cost saving in most age groups and vascular diseaserisk groups studied directly. Gains in life expectancy and costsavings decreased with increasing age and with decreasing riskof vascular disease. People aged 40-49 with 5 year risks ofmajor vascular events of 42% and 12% at start of treatment gained2.49 and 1.67 life years, respectively. Treatment with statinsremained cost saving or cost less than £2500 per life yeargained in people as young as 35 years or as old as 85 with 5year risks of a major vascular event as low as 5% at the startof treatment.

Conclusions Treatment with statins is cost effectivein a wider population than is routinely treated at present.

(Accepted 22 September 2006)

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Rapid Responses:

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