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.
- CHD, coronary heart disease
- CEA, cost effectiveness analyses
- CER, cost effective ratio
- CVD, cardiovascular disease
- cardiovascular disease
- coronary heart disease
- cost effectiveness analysis
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Funding: OHF, AP, CWNL, and LB were partly funded by the Netherlands Organisation for Scientific Research (ZON-MW). This funding organisation did not participate in the design and conduct of the study, collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
Competing interests: none.
This manuscript has been presented before (as an abstract) in a poster in the 2003 Congress of the European Society of Cardiology (Vienna, Austria, September 2003), in an oral presentation in the 2004 World Congress of Public Health (Brighton, UK, 20 April 2004), and in an oral presentation during the conference of the Health Technology Assessment International group 2004 (Krakow, Poland, 1 June 2004).
Ethical approval was not required as this was a secondary data analysis.
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