Statin treatment for primary prevention of vascular disease: whom to treat? Cost-effectiveness analysis
BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1672 (Published 30 March 2011) Cite this as: BMJ 2011;342:d1672
- JP Greving, research fellow in clinical epidemiology1,
- FLJ Visseren, internist and professor of vascular medicine2,
- GA de Wit, associate professor of health technology assessment13,
- A Algra, professor of clinical epidemiology14
- 1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CX Utrecht, Netherlands
- 2Department of Vascular Medicine, University Medical Center Utrecht
- 3Center for Prevention and Health Services Research, National Institute of Public Health and the Environment, Bilthoven, Netherlands
- 4Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht
- Correspondence to: J P Greving J.P.Greving{at}umcutrecht.nl
- Accepted 29 December 2010
Abstract
Objective To assess the cost-effectiveness of low dose statins for primary prevention of vascular disease, incorporating current prices, non-adherence (reduced clinical efficacy while maintaining healthcare costs), and the results of the recently published JUPITER trial.
Design Cost-effectiveness analysis using a Markov model. Sensitivity analyses and Monte Carlo simulation evaluated the robustness of the results.
Setting Primary care in The Netherlands.
Participants Hypothetical populations of men and women aged 45 to 75 years without a history of vascular disease at different levels of risk for vascular disease (myocardial infarction and stroke) over 10 years.
Interventions Low dose statin treatment daily versus no treatment for 10 years.
Main outcome measures Number of fatal and nonfatal vascular events prevented, quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios over 10 years.
Results Over a 10-year period, statin treatment cost €35 000 (£30 000, $49 000) per QALY gained for men aged 55 years with a 10-year vascular risk of 10%. The incremental cost-effectiveness ratio improved as risk for vascular disease increased. The cost per QALY ranged from approximately €5000 to €125 000 when the 10-year vascular risk for men aged 55 years was varied from 25% to 5%. The incremental cost-effectiveness ratio slightly decreased with age after the level of vascular risk was specified. Results were sensitive to the costs of statin treatment, statin effectiveness, non-adherence, disutility of taking medication daily, and the time horizon of the model.
Conclusions In daily practice, statin treatment seemed not to be cost-effective for primary prevention in populations at low risk of vascular disease, despite low costs of generic drug pills. Adherence to statin treatment needs to be improved to enhance the cost-effectiveness of the use of statins for primary prevention.
Footnotes
Contributors: JPG developed the cost-effectiveness model, analysed the data, and wrote the manuscript. She is guarantor. GAdW, AA, and FLV contributed to model development and data collection, and critically revised the manuscript.
Funding: This study was supported by an unconditional grant from the Netherlands Organisation for Health Research and Development (ZonMW, project number 6120.0019). The funding source had no involvement in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit an article for publication.
Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that: the submitted work was supported only by ZonMW; JPG, GAdW, and AA have no relationships with companies that might have an interest in the submitted work in the previous three years; the department of FLV has received research grants from Merck, the Netherlands Organisation for Health research and Development and from the Catharijne foundation Utrecht and speaker fees from Merck and AstraZeneca; none of the authors has non-financial interests that may be relevant to the submitted work.
Ethical approval: Not required.
Data sharing: No additional data available.
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.