A new study led by Oxford Population Health’s Health Economics Research Centre has shown that statin therapy is a cost-effective way of reducing the risks of heart disease and stroke in adults aged 70 years and over, irrespective of whether or not they have a history of cardiovascular disease. The study is published in Heart.
Heart disease and stroke are leading causes of death and disability around the world. As we age, our risk of having a heart attack or a stroke increases. Having high levels of low-density lipid (LDL) or ‘bad’ cholesterol in your blood can further increase your risk. Statins are a type of medicine that lower levels of LDL cholesterol and can reduce risk of heart attacks and stroke.
This study aimed to find out whether, given the current best evidence of statins’ effects on risks of heart attack and stroke in people over 70 years old, statins improve their overall health and whether they are cost-effective. To find this out, the researchers used a meta-analysis of individual participant data in large statins trials that are part of the Cholesterol Treatment Trialists’ Collaboration and a model of lifetime effects and cost-effectiveness of statin therapy that they had previously created using data from these trials and participants in the UK Biobank study.
The model takes into account each of the participants’ characteristics and predicts the influence of statin therapy on their risk of heart disease, their health-related quality of life, and their health-related care costs over their lifetimes.
The researchers assessed the value of treatment with statins for different groups of older people. They applied the model to data from 20,122 participants 70 years old and over in the UK Biobank and Whitehall II studies.
Key findings:
Statins were found to increase quality of life-adjusted survival and were cost-effective for both men and women aged over 70 years irrespective of whether or not they had a prior history of heart disease or stroke and their LDL cholesterol levels;
- Use of a standard statin (reducing low density lipoprotein by 35%-45%) increased Quality Adjusted Life Years (QALYs)* by 0.24–0.70;
- The cost per QALY gained was below £3,502 for standard intensity therapy, well under the current minimum threshold for good-value interventions of £20,000 per QALY gained;
When compared with standard doses, higher doses of statins were found to increase the benefits by a further 0.04–0.13 QALYs per person, and were cost-effective (below £11,778) in most older adults except women who had lower LDL cholesterol levels.
Borislava Mihaylova, Associate Professor and Senior Health Economist at Oxford Population Health, said ‘Many people around the world are suffering from preventable heart disease and stroke due to insufficient access to effective low-cost treatments such as statins. The results of our study demonstrate that improving access to statins for older adults could improve their health and that this would be cost-effective.’
The research is a collaboration between Oxford Population Health, Queen Mary University of London, and the University of Sydney. It was funded by the National Institute for Health and Care Research.
*Quality Adjusted Life Years (QALYs) are a standard metric used to compare the cost-effectiveness of different healthcare interventions. One QALY is equivalent to an additional year gained at full health.