EVIDENCE BASED PUBLIC HEALTH POLICY AND PRACTICE

Cost effectiveness of statins in coronary heart disease

Oscar H Franco¹, Anna Peeters², Caspar W N Looman¹ and Luc Bonneux³

¹ Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Netherlands
² Department of Epidemiology and Preventive Medicine, Monash University Central and Eastern Clinical School, Melbourne, Australia
³ Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium

Correspondence to:
Correspondence to:
Dr O H Franco
Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, PO Box 1738, office Ee 2006, 3000 DR Rotterdam, Netherlands; o.francoduran{at}erasmusmc.nl

Introduction: Statin therapy reduces the rate of coronary heart disease, but high costs in combination with a large population eligible for treatment ask for priority setting. Although trials agree on the size of the benefit, economic analyses of statins report contradictory results. This article reviewed cost effectiveness analyses of statins and sought to synthesise cost effectiveness ratios for categories of risk of coronary heart disease and age.

Methods: The review searched for studies comparing statins with no treatment for the prevention of either cardiovascular or coronary heart disease in men and presenting cost per years of life saved as outcome. Estimates were extracted, standardised for calendar year and currency, and stratified by categories of risk, age, and funding source

Results: 24 studies were included (from 50 retrieved), yielding 216 cost effectiveness ratios. Estimated ratios increase with decreasing risk. After stratification by risk, heterogeneity of ratios is large varying from savings to $59 000 per life year saved in the highest risk category and from $6500 to $490 000 in the lowest category. The pooled estimates show values of $21571 per life year saved for a 10 year coronary heart disease risk of 20% and $16862 per life year saved for 10 year risk of 30%.

Conclusion: Statin therapy is cost effective for high levels of risk, but inconsistencies exist at lower levels. Although the cost effectiveness of statins depends mainly on absolute risk, important heterogeneity remains after adjusting for absolute risk. Economic analyses need to increase their transparency to reduce their vulnerability to bias and increase their reproducibility.

Abbreviations: CHD, coronary heart disease; CEA, cost effectiveness analyses; CER, cost effective ratio; CVD, cardiovascular disease

Keywords: statins; cardiovascular disease; coronary heart disease; cost effectiveness analysis

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