Cholesterol lowering cost-effective in high-risk elderly
Clinical Question
What is the cost-effectiveness of pravastatin treatment of high-risk patients aged 65 years to 75 years?
Bottom Line
From the viewpoint of a health system, it is cost-effective to treat high-risk patients older than 65 years with pravastatin (Pravachol) no matter what their level of initial cholesterol level. The increased cost of treatment is partially offset by savings in other areas. This analysis did not take into account any effect on the quality of the life extension by pravastatin. (LOE = 2c)
Reference
Tonkin AM, Eckermann S, White H, et al, for the LIPID Study Group. Cost-effectiveness of cholesterol-lowering therapy with pravastatin in patients with previous acute coronary syndromes aged 65-74 years compared with younger patients: Results from the LIPID study. Am Heart J 2006;151:1305-1312. [PMID:16781242]
Study Design
Cost-effectiveness analysis
Funding
Unknown/not stated
Setting
Outpatient (any)
Synopsis
The Australian researchers conducting this study used data from the LIPID study conducted in the early 1990s to estimate the relative cost of treating high-risk patients with pravastatin to lower their risk of mortality and hospitalization. The perspective was from the viewpoint of the healthcare system. The 9014 patients had a history of either myocardial infarction or unstable angina, a cholesterol level ranging from 115 mg/dL to 271 mg/dL (4.0 - 7.0 mmol/L), and were randomly treated with placebo or pravastatin 40 mg daily for 6 years. This analysis evaluated the cost-effectiveness of the treatment in patients between the ages of 65 years and 75 years as compared with patients younger than 65 years. To determine cost the authors used actual data on hospitalizations, office visits, diagnostic tests, nursing home stays, and medications, expressed as Australian dollars and reflecting costs to the Australian healthcare system. No utilities were used to evaluate outcomes; that is, the researchers did not evaluate the effect of treatment on quality of life. The analysis was based on a decrease in all-cause mortality from 20.6% to 16.3% in older patients and from 9.8% to 7.5% in younger patients. This translates into an additional 4.7 months to 4.8 months of additional life in the average patient. The average cost-per-patient for treatment was A$4792 for older patients and A$4989 in younger patients. These costs were somewhat offset in both groups by decreases in the costs of other medications, hospitalizations, and other costs. The overall additional cost of treatment was lower for older patients (A$2140 for older patients, A$3539 for younger patients). For every 1000 patients aged 65 years to 74 years, pravastatin treatment for 6 years prevented 43 deaths at a cost of A$2.1 million, or A$55,474 per life saved. In the younger patient group, 31 deaths were prevented at a cost of A$3.5 million, or A$167,161 per life saved. These estimates were not adjusted for quality of life; thus, the quality of a life saved in the younger group could be better than that of a life saved in the older group. As a result, quality-adjusted life estimates, which takes more into account the viewpoint of the patient could be different from these estimates.
Citation
Barry, Henry, et al., editors. "Cholesterol Lowering Cost-effective in High-risk Elderly." EE+ POEM Archive, John Wiley & Sons, 2024. Evidence Central, evidence.unboundmedicine.com/evidence/view/infoPOEMs/426280/all/Cholesterol_lowering_cost_effective_in_high_risk_elderly.
Cholesterol lowering cost-effective in high-risk elderly. In: Barry HH, Ebell MHM, Shaughnessy AFA, et al, eds. EE+ POEM Archive. John Wiley & Sons; 2024. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426280/all/Cholesterol_lowering_cost_effective_in_high_risk_elderly. Accessed November 3, 2024.
Cholesterol lowering cost-effective in high-risk elderly. (2024). In Barry, H., Ebell, M. H., Shaughnessy, A. F., & Slawson, D. C. (Eds.), EE+ POEM Archive. John Wiley & Sons. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426280/all/Cholesterol_lowering_cost_effective_in_high_risk_elderly
Cholesterol Lowering Cost-effective in High-risk Elderly [Internet]. In: Barry HH, Ebell MHM, Shaughnessy AFA, Slawson DCD, editors. EE+ POEM Archive. John Wiley & Sons; 2024. [cited 2024 November 03]. Available from: https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426280/all/Cholesterol_lowering_cost_effective_in_high_risk_elderly.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Cholesterol lowering cost-effective in high-risk elderly
ID - 426280
ED - Barry,Henry,
ED - Ebell,Mark H,
ED - Shaughnessy,Allen F,
ED - Slawson,David C,
BT - EE+ POEM Archive
UR - https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426280/all/Cholesterol_lowering_cost_effective_in_high_risk_elderly
PB - John Wiley & Sons
DB - Evidence Central
DP - Unbound Medicine
ER -