Lifetime effects and cost-effectiveness of statin therapy for older people in the United Kingdom: a modelling study.

Background: Cardiovascular disease (CVD) risk increases with age. Statins reduce cardiovascular risk but their effects are less certain at older ages. We assessed the long-term effects and cost-effectiveness of statin therapy for older people in the contemporary UK population using a recent meta-analysis of randomised evidence of statin effects in older people and a new validated CVD model.
Methods: The performance of the CVD microsimulation model, developed using the Cholesterol Treatment Trialists' Collaboration (CTTC) and UK Biobank cohort, was assessed among participants ≥70 years old at (re)surveys in UK Biobank and the Whitehall II studies. The model projected participants' cardiovascular risks, survival, quality-adjusted life years (QALYs) and healthcare costs (2021 UK£) with and without lifetime standard (35%-45% low-density lipoprotein cholesterol reduction) or higher intensity (≥45% reduction) statin therapy. CTTC individual participant data and other meta-analyses informed statins' effects on cardiovascular risks, incident diabetes, myopathy and rhabdomyolysis. Sensitivity of findings to smaller CVD risk reductions and to hypothetical further adverse effects with statins were assessed.
Results: In categories of men and women ≥70 years old without (15,019) and with (5,103) prior CVD, lifetime use of a standard statin increased QALYs by 0.24-0.70 and a higher intensity statin by a further 0.04-0.13 QALYs per person. Statin therapies were cost-effective with an incremental cost per QALY gained below £3502/QALY for standard and below £11778/QALY for higher intensity therapy and with high probability of being cost-effective. In sensitivity analyses, statins remained cost-effective although with larger uncertainty in cost-effectiveness among older people without prior CVD.
Conclusions: Based on current evidence for the effects of statin therapy and modelling analysis, statin therapy improved health outcomes cost-effectively for men and women ≥70 years old.
Competing Interests: Competing interests: AK reports research support from Abbott, Amgen, ASPEN, Bayer, Mylan, Novartis, Sanofi, Viatris; speaker fees from Novartis; and is a Data Safety Monitoring Board member for Kowa. JR reports funding from North East London Integrated Care Service. JA reports receiving a grant to their research institution from Novartis for the ORION 4 trial of inclisiran. JS reports receiving grants for his institution from Amgen, Bayer, BMS, MSD, Pfizer and Roche; consulting fees from FivepHusion, and is a chair (unpaid) of STAREE DSMB. CB reports research grants from Boehringer Ingelheim and Health Data Research UK and is a chair (unpaid) of a Data Safety Monitoring Board for Merck. All other authors declare no competing interests.
(© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)