Statin use is cost effective and linked to improved health outcomes in people aged over 70 with and without previous cardiovascular disease, according to results from a study published in Heart.
Statins are used extensively to prevent cardiovascular events in middle-aged people, but evidence to support use in older adults, especially those without a history of cardiovascular disease, has been less definitive, and guidelines have not recommended them for this group. Despite cardiovascular risk increasing with age, statins use is lower among the over 70s.
This observational study modelled the lifetime effects and cost-effectiveness of statin therapy in people aged ≥70, projecting cardiovascular risks, survival, quality-adjusted life years (QALYs) and healthcare costs of statin use in 5103 subjects with and 15,019 without prior cardiovascular disease.
Results indicate that lifetime use of a standard statin (reducing low density lipoprotein by 35-45%) increased QALYs by 0.24-0.70 per person. A higher intensity statin therapy (≥45% low density lipoprotein reduction) increased QALYs by a further 0.04-0.13 QALYs per person. Use of statins was cost-effective, with the cost per QALY gained below £3502 for standard therapy and below £11,778 for higher intensity therapy, both well under the current threshold for good-value interventions of about £20000 per QALY gained. Statins remained cost-effective in sensitivity analyses with assumed lower efficacy, although with larger uncertainty for cost-effectiveness among older people without prior cardiovascular disease.
Authors say the robustness of their findings indicates that most older people are likely to benefit cost-effectively from statin therapy. While ongoing statin trials in older people without CVD will add valuable data, particularly in those over age 75, statin treatment of individuals should not be delayed while awaiting their findings.
Borislava Mihaylova, Professor of Health Economics, and WIPH Unit for Health Economics and Policy Research Lead said: ‘Many people around the world are suffering from preventable heart disease and stroke due to insufficient access to effective low-cost treatments such as statins. The results of our study demonstrate that improving access to statins for older adults could improve their health and that this would be cost-effective.’
This research is a collaboration from researchers at Queen Mary University of London, Oxford Population Health, and the University of Sydney, and was funded by the National Institute for Health and Care Research Health Technology Assessment funding portfolio.
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. Lifetime effects and cost-effectiveness of statin therapy for older people in the United Kingdom: a modelling study. Heart, 10 September 2024. doi: 10.1136/heartjnl-2024-324052