A comprehensive modeling study from the United Kingdom has demonstrated that lifetime statin therapy is both cost-effective and beneficial for improving health outcomes in adults aged 70 years and older, regardless of their cardiovascular disease (CVD) history or LDL cholesterol levels.
The research, led by Borislava Mihaylova, MSc, DPhil, from the Health Economics Research Center at the University of Oxford, utilized contemporary patient data to evaluate the lifetime effects and economic implications of statin therapy in older adults.
Clinical Benefits Across Population Groups
The study analyzed data from 20,122 participants, including 15,019 individuals without prior CVD and 5,103 with CVD history. The findings revealed significant survival benefits from standard statin therapy, ranging from 0.37 to 1.05 additional life years, translating to 0.24 to 0.7 quality-adjusted life years (QALYs).
Higher-intensity statin regimens demonstrated even greater benefits, providing an additional 0.08 to 0.21 life years (0.04 to 0.13 QALYs) compared to standard therapy. These improvements were consistent across both primary and secondary prevention populations.
Economic Analysis Shows Strong Value
The economic evaluation revealed compelling cost-effectiveness metrics. For standard statin therapy, the incremental cost per QALY gained ranged from £116 to £3,502 when compared to no treatment. Higher-intensity regimens showed incremental costs of £2,213 to £11,778 per QALY compared to standard therapy.
"While further randomized evidence will be helpful, the robustness of these findings indicates that older people are likely to benefit cost-effectively from statin therapy and should be considered for treatment," stated Dr. Mihaylova and her team.
Methodology and Data Validation
The research team developed a CVD microsimulation model using data from the Cholesterol Treatment Trialists' Collaboration (CTTC) and UK Biobank cohorts. The model's performance was validated against participants aged ≥70 years from both the UK Biobank and Whitehall II studies.
At baseline, statin prescription rates were 29% among those without CVD and 58% for those with prior CVD. Untreated mean LDL-C levels were 4.2 mmol/L and 4.3 mmol/L for these cohorts, respectively.
Clinical Implications and Future Directions
The study's findings are particularly significant given the current gap in guideline recommendations for statin initiation in older populations for primary CVD prevention. While existing literature has shown that statins can reduce cardiovascular events by approximately 25% for every 1mmol/L reduction in LDL-C, specific guidance for older adults has been limited.
The researchers noted greater uncertainty regarding statin therapy's cost-effectiveness for older individuals without prior CVD, particularly in scenarios with substantially smaller CVD risk reductions. However, at the £20,000/QALY willingness-to-pay threshold, higher-intensity statin therapy maintained a high probability of cost-effectiveness across all studied cohorts.
