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

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7122.1577 (Published 13 December 1997) Cite this as: BMJ 1997;315:1577
  1. J Caro, scientific directora (jcaro{at}caroresearch.com),
  2. W Klittich, director of informaticsa,
  3. A McGuire, professorb,
  4. I Ford, professorc,
  5. J Norrie, research fellowc,
  6. D Pettitt, associate director of modellingd,
  7. J McMurray, professore,
  8. J Shepherd, professorf

    for the West of Scotland Coronary Prevention Study Group

  1. a Caro Research, 336 Baker Avenue, Concord, MA 01742, USA
  2. b City University, Department of Economics, London EC1V 0HB
  3. c University of Glasgow, Robertson Centre for Biostatistics, Glasgow G12 8QQ
  4. d Bristol-Myers Squibb Outcomes Research, PO Box 4000, Princeton, NJ 08543, USA
  5. e University of Glasgow, CRI in Heart Failure, Wolfson Building, Glasgow G12 8QQ
  6. f Department of Pathological Biochemistry, Royal Infirmary, Glasgow G4 0SF
  1. The members of the executive committee are listed at the end of the article. Correspondence to: Dr Caro
  • Accepted 29 July 1997

Abstract

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.

Key messages

  • The West of Scotland coronary prevention study showed that pravastatin can prevent cardiovascular disease in men with hypercholesterolaemia

  • So far, reports have deemed this prevention unjustified due to adverse economic implications

  • This analysis, based on data from the West of Scotland coronary prevention study and extensive data from the Scottish record linkage system, shows that using pravastatin in this way is worth considering because of its substantial clinical benefit at a reasonable cost

  • Practitioners must now consider using pravastatin to prevent cardiovascular disease in men with hypercholesterolaemia

  • Increased economic efficiency may be obtained by restricting prevention to patients with additional risk factors

Footnotes

    • Accepted 29 July 1997
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