Journal
EUROPEAN HEART JOURNAL
Volume 35, Issue 5, Pages 290-298Publisher
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/eht232
Keywords
Pravastatin; Cardiovascular outcomes; Record linkage; Cost effectiveness; Primary prevention
Categories
Funding
- Bristol-Myers Squibb
- Sankyo Company
- Pfizer
- Wellcome Trust
- Celera Diagnostics
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To assess the impact on healthcare resource utilization, costs, and quality of life over 15 years from 5 years of statin use in men without a history of myocardial infarction in the West of Scotland Coronary Prevention Study (WOSCOPS). Six thousand five hundred and ninety-five participants aged 4554 years were randomized to 5 years treatment with pravastatin (40 mg) or placebo. Linkage to routinely collected health records extended follow-up for secondary healthcare resource utilization to 15 years. The following new results are reported: cause-specific first and recurrent cardiovascular hospital admissions including myocardial infarction, heart failure, stroke, coronary revascularization and angiography; non-cardiovascular hospitalization; days in hospital; quality-adjusted life years (QALYs); costs of pravastatin treatment, treatment safety monitoring, and hospital admissions. Five years treatment of 1000 patients with pravastatin (40 mg/day) saved the NHS 710 000 (P 0.001), including the cost of pravastatin and lipid and safety monitoring, and gained 136 QALYs (P 0.017) over the 15-year period. Benefits per 1000 subjects, attributable to prevention of cardiovascular events, included 163 fewer admissions and a saving of 1836 days in hospital, with fewer admissions for myocardial infarction, stroke, heart failure and coronary revascularization. There was no excess in non-cardiovascular admissions or costs (or in admissions associated with diabetes or its complications) and no evidence of heterogeneity of effect over sub-groups defined by baseline cardiovascular risk. Five years primary prevention treatment of middle-aged men with a statin significantly reduces healthcare resource utilization, is cost saving, and increases QALYs. Treatment of even younger, lower risk individuals is likely to be cost-effective.
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