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Long-term Cost-effectiveness of Statin Treatment for Primary Prevention of Cardiovascular Disease in the Elderly

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Abstract

Purpose

This study aimed to evaluate the cost-effectiveness of statins for primary prevention of stroke and myocardial infarction (MI) in the elderly in Singapore.

Methods

A Markov model was developed to investigate the lifetime costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) of statin treatment in those aged 65 years and older without a history of stroke or MI from the perspective of Singapore’s healthcare system, using elderly-specific clinical data and local costs from hospital databases. A lifetime horizon was used and all costs and health outcomes were discounted at 3 % annually.

Results

In the base-case analysis, statin treatment prevented an additional four strokes and eight MIs among 1,000 “healthy” elderly individuals compared with no treatment. Statin treatment resulted in a QALY gain of 0.26 and additional costs of SGD 11,314 per person, yielding an ICER of SGD 43,925 (USD 33,495) per QALY gained. The results were sensitive to statin effectiveness, particularly statins’ effect on all-cause mortality, and cost of statin medication. Probabilistic sensitivity analysis demonstrated that the probability of statin treatment being cost-effective was 72 % at a willingness-to-pay threshold of SGD 65,000 (USD 49,546) per QALY gained. Shortening the time horizon from lifetime to 10 years (simulating limited life expectancy) considerably increased the ICER to SGD 291,313 (USD 167,171) per QALY. Female gender and younger age were also associated with higher ICERs owing to a lower baseline risk of cardiovascular disease (CVD) and higher costs to manage events in these subgroups.

Conclusions

Statin treatment for the primary prevention of CVD in the elderly was cost-effective. However, treatment warrants re-evaluation when the prognosis of the individual is considered less than ten years; other goals may take precedence over CVD prevention.

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Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Author information

Authors and Affiliations

  1. Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, 3 Fusionopolis Link, #03-08 Nexus@one-north, Singapore, 138543, Singapore

    Liang Lin, Monica Teng, Ying Jiao Zhao, Ai Leng Khoo & Boon Peng Lim

  2. Department of Neurology, National University Hospital, Singapore, Singapore

    Raymond Chee Seong Seet

  3. Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore

    Quek Wei Yong

  4. Department of Cardiology, National University Heart Centre, Singapore, Singapore

    Tiong Cheng Yeo

Authors
  1. Liang Lin
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  2. Monica Teng
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  3. Ying Jiao Zhao
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  4. Ai Leng Khoo
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  5. Raymond Chee Seong Seet
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Correspondence to Liang Lin.

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Lin, L., Teng, M., Zhao, Y.J. et al. Long-term Cost-effectiveness of Statin Treatment for Primary Prevention of Cardiovascular Disease in the Elderly. Cardiovasc Drugs Ther 29, 187–197 (2015). https://doi.org/10.1007/s10557-015-6584-7

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  • DOI: https://doi.org/10.1007/s10557-015-6584-7

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