ArticlesCost-effectiveness of simvastatin in people at different levels of vascular disease risk: economic analysis of a randomised trial in 20 536 individuals
Introduction
The MRC/BHF Heart Protection Study (HPS) has shown that lowering LDL cholesterol concentrations with 40 mg simvastatin daily produces substantial reductions in the rates of major vascular events (ie, heart attacks, strokes, and revascularisation procedures) among a wide range of high-risk individuals, irrespective of their pretreatment blood cholesterol concentrations.1, 2, 3, 4 Such treatment may, therefore, be cost effective for many types of high-risk patient who would not be prescribed statin therapy according to current guidelines.
The aim of this report is to estimate the cost-effectiveness of 40 mg simvastatin daily during the scheduled study treatment period among people at different underlying levels of risk for vascular events. This information should help determine appropriate risk thresholds for initiating statin therapy.
Section snippets
Methods
The perspective of these economic analyses is that of the UK National Health Service, and all costs are reported in UK£ for the year 2001 (ie, the year in which HPS ended).
Vascular and non-vascular events
Table 1 shows the risk of first major vascular event among HPS participants in univariate subgroups and multivariate risk quintiles, with the 5-year risk ranging widely from 42% in the highest risk quintile to 12% in the lowest. It also shows the 5-year risk of first major coronary event (ie, non-fatal myocardial infarction or coronary death), which is the outcome most commonly used as a basis for treatment guidelines, and the risk of vascular death. In previous HPS analyses,2, 3, 4 allocation
Discussion
The present analyses demonstrate clearly that the cost-effectiveness of statin therapy among a wide range of individuals with vascular disease or diabetes depends chiefly on their underlying risk of vascular events and the costs of statins. Previous analyses of HPS had involved intention-to-treat comparisons of all those allocated simvastatin versus all those allocated placebo. But, since an average of about a sixth of those allocated simvastatin stopped taking the study drug during the 5 year
References (23)
MRC/BHF Heart Protection Study of cholesterol-lowering therapy and of antioxidant vitamin supplementation in a wide range of patients at increased risk of coronary heart disease death: early safety and efficacy experience
Eur Heart J
(1999)MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebo-controlled trial
Lancet
(2002)MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial
Lancet
(2003)MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin on stroke and other major vascular events in 20 536 people with cerebrovascular disease or other high risk conditions
Lancet
(2004)Trust financial returns
(2001)Trust financial returns
(2002)British National Formulary 41
(2001)Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies
Lancet
(2002)Some problems in interval estimation
J R Stat Soc (Series B)
(1954)- et al.
An introduction to the bootstrap
(1993)
Cost effectiveness analysis of improved blood pressure control in hypertensive patients with type 2 diabetes: UKPDS 40
BMJ
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Collaborators and participating hospitals listed at http://image.thelancet.com/extras/04art2126webappendix.pdf