Cholesterol lowering cost-effective in high-risk elderly
Clinical QuestionWhat is the cost-effectiveness of pravastatin treatment of high-risk patients aged 65 years to 75 years?
Bottom LineFrom 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)
ReferenceTonkin 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 DesignCost-effectiveness analysis
SynopsisThe 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.
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