Ischaemic heart disease: Risk stratification affects cost-effectiveness of statin therapy

Clinical bottom line (level 2b)

  1. In patients with raised cholesterol, the cost-effectiveness of treatment varies with number of risk factors present
Pharaoh and Hollingworth: BMJ 1996; 312: 1443-1448
Expires March 2003

The study

cost-effectiveness analysis using a lifetable method
Setting: theoretical health authority population

census data for mortality statistics; 4S and WOSCOPS trials for efficacy data

  • Viewpoint: area health purchaser
  • Benefit assessment: costs per life saved; incremental costs per life saved
  • Resources and costs: local hospital costs for intervention data; discount rate of 5% applied
  • Sensitivity analysis: multiple comparisons using a Hypercube method of values within the confidence limits of point estimates

    • The evidence

    intervention cost
    treatment of mean 45-64 and women 55-64 with previous MI and cholesterol >5.4 mmol/L average cost 16,000 per year
    including similar patients with angina average cost 26,000/year ; marginal cost 47,000/year
    adding men 55-64y with no history of heart disease but cholesterol >6.4mmol/L average cost 51,000/year: marginal cost 81,000/year
    adding women with previous MI or angina aged 45-54y average cost 53,000/year: marginal cost 143,000/year

    Comments

    1. Good analysis with sensible sensitivity analyses

    Citation

    1. Pharaoh PDP, and Hollingworth W: Cost effectiveness of lowering cholesterol concentration with statins in patients with and without pre-existing coronary heart disease: life table method applied to a health authority population. BMJ 1996; 312: 1443-1448
    Contributor: Bob Phillips, November 1999
    Reviewer:

    Clinical Question.
    Patient patients with or without preexisting coronary artery disease
    Intervention or Exposure prescription of statins
    Outcome cost-effectiveness