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. 2024 Dec;28(79):1–134. doi: 10.3310/KDAP7034

Assessing long-term effectiveness and cost-effectiveness of statin therapy in the UK: a modelling study using individual participant data sets.

Borislava Mihaylova, Runguo Wu, Junwen Zhou, Claire Williams, Iryna Schlackow, Jonathan Emberson, Christina Reith, Anthony Keech, John Robson, Richard Parnell, Jane Armitage, Alastair Gray, John Simes, Colin Baigent
PMCID: PMC11647556  PMID: 39644281

Abstract

BACKGROUND

Cardiovascular disease has declined but remains a major disease burden across developed countries.

OBJECTIVE

To assess the effectiveness and cost-effectiveness of statin therapy across United Kingdom population categories.

DESIGN

The cardiovascular disease microsimulation model, developed using Cholesterol Treatment Trialists' Collaboration data and the United Kingdom Biobank cohort, projected cardiovascular events, mortality, quality of life and healthcare costs using participant characteristics.

SETTING

United Kingdom primary health care.

PARTICIPANTS

A total of 117,896 participants in 16 statin trials in the Cholesterol Treatment Trialists' Collaboration; 501,854 United Kingdom Biobank participants by previous cardiovascular disease status, sex, age (40-49, 50-59 and 60-70 years), 10-year cardiovascular disease risk [QRISK®3 (%): < 5, 5-10, 10-15, 15-20 and ≥ 20] and low-density lipoprotein cholesterol level (< 3.4, 3.4-4.1 and ≥ 4.1 mmol/l); 20,122 United Kingdom Biobank and Whitehall II participants aged ≥ 70 years by previous cardiovascular disease status, sex and low-density lipoprotein cholesterol (< 3.4, 3.4-4.1 and ≥ 4.1 mmol/l).

INTERVENTIONS

Lifetime standard (35-45% low-density lipoprotein cholesterol reduction) or higher-intensity (≥ 45% reduction) statin.

MAIN OUTCOME MEASURES

Quality-adjusted life-years and incremental cost per quality-adjusted life-year gained from the United Kingdom healthcare perspective.

DATA SOURCES

Cholesterol Treatment Trialists' Collaboration and United Kingdom Biobank data informed risk equations. United Kingdom primary and hospital care data informed healthcare costs (2020-1 Great British pounds); £1.10 standard or £1.68 higher-intensity generic statin therapy per 28 tablets; and Health Survey for England data informed health-related quality of life. Meta-analyses of trials and cohort studies informed the effects of statin therapies on cardiovascular events, incident diabetes, myopathy and rhabdomyolysis.

RESULTS

Across categories of participants 40-70 years old, lifetime use of standard statin therapy resulted in undiscounted 0.20-1.09 quality-adjusted life-years gained per person, and higher-intensity statin therapy added a further 0.03-0.20 quality-adjusted life-years per person. Among participants aged ≥ 70 years, lifetime standard statin was estimated to increase quality-adjusted life-years by 0.24-0.70 and higher-intensity statin by a further 0.04-0.13 quality-adjusted life-years per person. Benefits were larger among participants at higher cardiovascular disease risk or with higher low-density lipoprotein cholesterol. Standard statin therapy was cost-effective across all categories of people 40-70 years old, with incremental costs per quality-adjusted life-year gained from £280 to £8530. Higher-intensity statin therapy was cost-effective at higher cardiovascular disease risk or higher low-density lipoprotein cholesterol. Both standard and higher-intensity statin therapies appeared to be cost-effective for people aged ≥ 70 years, with an incremental cost per quality-adjusted life-year gained of under £3500 for standard and under £11,780 for higher-intensity statin. Standard or higher-intensity statin therapy was certain to be cost effective in the base-case analysis at a threshold of £20,000 per quality-adjusted life-year. Statins remained cost-effective in sensitivity analyses.

LIMITATIONS

The randomised evidence for effects of statin therapy is for about 5 years of treatment. There is limited randomised evidence of the effects of statin therapy in older people without previous cardiovascular disease.

CONCLUSIONS

Based on the current evidence of the effects of statin therapy and modelled contemporary disease risks, low-cost statin therapy is cost-effective across all categories of men and women aged ≥ 40 years in the United Kingdom, with higher-intensity statin therapy cost-effective at higher cardiovascular disease risk or higher low-density lipoprotein cholesterol.

FUTURE WORK

Cholesterol Treatment Trialists' Collaboration has ongoing studies of effects of statin therapy using individual participant data from randomised statin trials. Ongoing large randomised controlled trials are studying the effects of statin therapy in people ≥ 70 years old. Future economic analyses should integrate the emerging new evidence.

FUNDING

This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/140/02) and is published in full in Health Technology Assessment; Vol. 28, No. 79. See the NIHR Funding and Awards website for further award information.

Plain language summary

Cardiovascular disease, such as heart attack or stroke, is a major cause of death and disability worldwide. Statins, a medication that reduces the level of cholesterol, have been reliably shown to reduce cardiovascular risk. They are available at low cost, are generally safe, and are widely recommended for people with or at increased risk of cardiovascular disease. However, it is uncertain whether the right people in the United Kingdom are recommended to receive this treatment and whether there are further categories of people who can benefit. We set out to assess the benefits and value for money of statins across people in the United Kingdom depending on their sex, age, cholesterol level, whether they already had cardiovascular disease, and if not, their estimated risk of developing it, to resolve remaining uncertainties. We used data from large statin studies and large contemporary United Kingdom population studies to develop a model to predict future cardiovascular disease, mortality, quality of life and healthcare costs for different people with and without statin treatment. We found that all people aged 40 years or older, whether men or women, younger or older, and independent of their level of cholesterol or cardiovascular risk, are highly likely to benefit cost-effectively from statin therapy to reduce their cardiovascular risk. We project that long-term statin treatment would increase people’s length and quality of life, with people at higher cardiovascular risk or with higher levels of cholesterol benefiting most. For most categories, more potent statin regimens that achieve larger cholesterol reductions provide the best value, although standard statin regimens may be enough for men and women at lower cardiovascular risk or with lower cholesterol levels. This study suggests that statin treatment should be strengthened among people at higher cardiovascular risk, and extending statin treatment to further categories of people aged 40 years or older should be considered.

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