peeters-costeffectiveness-2005.pdf (107.79 kB)
Cost effectiveness of statins in coronary heart disease
journal contribution
posted on 2005-11-01, 00:00 authored by O H Franco, Anna PeetersAnna Peeters, C W N Looman, L BonneuxINTRODUCTION: Statin therapy reduces the rate of coronary heart disease, but high costs in combination with a large population eligible for treatment ask for priority setting. Although trials agree on the size of the benefit, economic analyses of statins report contradictory results. This article reviewed cost effectiveness analyses of statins and sought to synthesise cost effectiveness ratios for categories of risk of coronary heart disease and age. METHODS: The review searched for studies comparing statins with no treatment for the prevention of either cardiovascular or coronary heart disease in men and presenting cost per years of life saved as outcome. Estimates were extracted, standardised for calendar year and currency, and stratified by categories of risk, age, and funding source RESULTS: 24 studies were included (from 50 retrieved), yielding 216 cost effectiveness ratios. Estimated ratios increase with decreasing risk. After stratification by risk, heterogeneity of ratios is large varying from savings to $59 000 per life year saved in the highest risk category and from 6500 dollars to 490,000 dollars in the lowest category. The pooled estimates show values of 21571 dollars per life year saved for a 10 year coronary heart disease risk of 20% and 16862 dollars per life year saved for 10 year risk of 30%. CONCLUSION: Statin therapy is cost effective for high levels of risk, but inconsistencies exist at lower levels. Although the cost effectiveness of statins depends mainly on absolute risk, important heterogeneity remains after adjusting for absolute risk. Economic analyses need to increase their transparency to reduce their vulnerability to bias and increase their reproducibility.
History
Journal
Journal of epidemiology & community healthVolume
59Issue
11Pagination
927 - 933Publisher
BMJ Publishing GroupLocation
London, Eng.Publisher DOI
Link to full text
ISSN
0143-005XLanguage
engPublication classification
C1.1 Refereed article in a scholarly journalCopyright notice
[2005, BMJ Publishing Group]Usage metrics
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No categories selectedKeywords
AdultAgedCoronary DiseaseCost of IllnessCost-Benefit AnalysisHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleMiddle AgedModels, EconomicQuality-Adjusted Life YearsScience & TechnologyLife Sciences & BiomedicinePublic, Environmental & Occupational HealthCOA REDUCTASE INHIBITORSSECONDARY PREVENTIONPRIMARY-CARETREATING HYPERLIPIDEMIAMYOCARDIAL-INFARCTIONECONOMIC-EVALUATIONCHOLESTEROL LEVELSARTERY-DISEASETHERAPYPRAVASTATIN
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